Hydrocephalus is a combination of the words hydro=water and cephali=head. It is commonly known as excessive accumulation of water in the brain. The water referred to here is “cerebrospinal fluid”. The increase in the amount of this fluid in some chambers of the brain causes the pressure in the head to rise and the brain to be damaged.
Cerebrospinal fluid is made and reabsorbed continuously throughout the day. This fluid surrounds the brain and spinal cord and has a continuous circulation. It has three main functions: to reduce the harmful effects of blows to the brain and spinal cord, to help feed the brain and to transport wastes, to regulate pressure changes in the brain by circulating between the brain and spinal cord.
Hydrocephalus can occur at any age, but it often occurs in children and the elderly (over 60 years of age). Hydrocephalus is seen in approximately one in 500 children. Most of these patients are diagnosed at birth, prenatally or in early infancy. Although rare, it may be due to genetic (inherited) disorders or developmental disorders. Common causes; intracerebral hemorrhages, head traumas, brain tumors, hemorrhages due to preterm birth and meningitis.
Findings: The findings of hydrocephalus vary from person to person. Common findings are listed below according to age groups.
Neonatal (0-2 months); Overgrowth of the head, thinning of the scalp, prominent veins in the head, vomiting, restlessness, drooping eyes, seizures, or inability to communicate.
Children (2 months and older); Abnormal growth of the head, headache, nausea, vomiting, fever, double vision, restlessness, regression in walking or speaking, communication disorder, loss of sensory-motor functions, seizures. Older children may have difficulty staying awake or waking up.
In middle-aged adults; Headache, difficulty in waking up or staying awake, balance disorder, urinary incontinence, personality disorder, dementia (dementia), visual impairment
In the elderly; Disturbance in communication, instability in walking, difficulty in remembering, headache, urinary incontinence.
In a patient with hydrocephalus, your doctor will talk to you before starting a treatment, ask questions, examine you, and request some tests (Brain Tomography, MMagnetic Resonance Imaging, Brain Ultrasonography). The diagnosis of hydrocephalus, why it occurs and what kind of treatment process it requires will be determined after these examinations. Only a large head in children does not indicate hydrocephalus. However, the diagnosis is confirmed using imaging techniques of the brain.
If the diagnosis is made before the baby is born in the womb; In order to terminate the pregnancy according to the laws in force, the report to be given by the ethics committee of the hospitals is needed.
Causes of Hydrocephalus:
Causes of hydrocephalus vary according to age group.
1-Neonatal (0-2 months): Congenital: These patients constitute the largest group. It may be only hydrocephalus or may be associated with other congenital anomalies (meningomyelocele) developing in the spine. Intra-cerebral hemorrhages: Brain chambers enlarge, usually after spontaneous hemorrhages.
2-Children and adults: Brain infections, brain hemorrhages, brain tumors and head traumas.
3- Elderly: Normal pressure hydrocephalus; is the enlargement of the brain chambers after decreased absorption of cerebrospinal fluid.
Hydrocephalus Treatment
It is not possible to treat hydrocephalus with drugs. Hydrocephalus can be corrected only with surgical interventions by neurosurgeons. The types of surgical intervention to be chosen will differ according to the underlying cause of hydrocephalus.
If there is an obstruction that causes the circulation of the cerebrospinal fluid to deteriorate, surgical treatment can be performed for the obstruction (tumor, cyst, etc.) If the obstruction cannot be cleared, the intracranial circulation paths of the cerebrospinal fluid can be changed with surgical interventions.
Since it is not possible to restore the circulation of the cerebrospinal fluid in the majority of patients, the fluid must be transferred from the brain to another body cavity. A thin long elastic silicone tube called a “shunt” is used for this transfer. There is a part of the system called a “pump” under the scalp for one-way and controlled speed operation. Excess cerebrospinal fluid is carried to another part of the body through this thin tube. Thus, the increase in pressure in the brain is prevented. However, since water is continuously produced in the brain, this system has to work continuously. Because the shunt is under the skin, it can only be noticed from the outside in babies. In children and adults, the tube under the skin can be felt when palpated.
The most commonly used method in babies diagnosed while in the womb; It is to deliver the baby as early as possible and to perform the surgery in the earliest period.
The shunt is surgically placed under general anesthesia. A small hole is made in the skull and the tip of the shunt is placed in the chamber in the brain where the cerebrospinal fluid is located. Then, a tunnel is opened under the skin of the head, neck and abdomen, and the other end of the shunt is directed into the heart or abdominal cavity, where this fluid can be easily absorbed. Short-term antibiotics can be used to prevent post-operative infection.
After surgery, the patient is observed in the hospital for a while. Usually, the patient’s complaints resolve after a while. However, if permanent damage to the brain tissue has occurred, some functions of the patient may not improve. The most important reason why functions such as vision and intelligence do not improve is the delay in treatment. The length of stay in the hospital varies according to the patient’s recovery status. These patients need long-term follow-up to monitor whether the shunt is working. A significant portion of patients treated for hydrocephalus can lead a normal life. The shunt may not work and may need to be replaced in cases of infection.
The shunt does not need a power source such as a battery.
Head x-ray and brain tomography do not harm the shunt system. The shunt type must be suitable for magnetic resonance examination. If there is a shunt whose pressure can be adjusted externally and affected by magnetic field, your doctor should be asked before performing a magnetic resonance examination.
In any shunt type, it cannot be pressed from the outside and operated by hand. The doctor performs a manual examination of the shunt. Overpressuring the pump will cause it to malfunction.
It is not appropriate to lay the baby on the side of the shunt, especially during infancy.
The dependence of the brain on the shunt system may continue for many years. In most of the patients, the need for shunt continues for life. Removal of the shunt is not recommended unless there is a problem in most patients.
Things to consider:
In order to prevent shunt complications, regular and frequent examinations should be performed. If;
*redness and tenderness at the operating site and on the shunt line,
*patient restlessness, nausea, vomiting,
*headache, double vision, fever, abdominal pain, convulsion
*If there is recurrence of preoperative complaints
, a doctor should be consulted. If problems are not detected and corrected early, dire consequences can occur, which can lead to death. Problems related to shunt can develop very quickly, sometimes within hours. In case of any doubt, it will be important to reach the nearest neurosurgery center and/or your doctor who performed the surgery.
