Hydrocephalus in Children
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Transcript of Hydrocephalus in Children
Hydrocephalus in ChildrenLeslie Acakpo-Satchivi, MD-PhD, Neurosurgery
www.SpringfieldClinic.comwww.SpringfieldClinic.com
What is Hydrocephalus
• “Water on the Brain”
• CSF constantly produced and absorbed
• Caused by lack of absorption
• Results in increased fluid pressure in brain
• Can be present at birth or later in life
Function of CSF
• Maintenance of a constant external environment for neurons and glia
• Mechanical cushion to protect the brain and provide buoyancy to the heavy brain (1400 g)
• Serves as a lymphatic system and a conduit for neuropeptides
• pH of CSF regulates pulmonary ventilation and CBF
Causes
• Congenital
• Acquired– Prematurity– Infection– Tumor– Bleeding in brain– Trauma
Signs and Symptoms
• In Young Children– Abnormal increase in head size– Irritability– Sleepiness– Vomiting– “Sunset” eyes
Signs and Symptoms
• In older Children– Headache– Poor school performance– Loss of coordination and difficulty walking– Sleepiness– Vomiting– Loss of bladder control
Treatment Goals
• To restore normal pressure in head– 1. restoring normal CSF flow– 2. divert CSF to another part of body
From Anatomography website maintained by Life Science Databases(LSDB)
Ventricular Anatomy
From: Gray’s anatomy
Causes of OBSTRUCTIVE Hydrocephalus
• Congenital Malformations– Aqueductal Stenosis– Arachnoid Cysts
• Acute Post-hemorrhagic
• Mass lesion
Causes of COMMUNICATINGHydrocephalus
•Defective absorption of CSF– Chronic Post-hemorrhagic– Chronic Post-Infectious
•Venous drainage insufficiency
•Overproduction of CSF (RARE)
Normal Head CT
Hydrocephalus
Aqueductal Stenosis
• Obstructive hydrocephalus
• Most common cause of congenital HCP (43%)
• Asymptomatic at early age
• OFC increase
• May present later with headaches
Endoscopic3rd
Ventriculostomy
(ETV)
Before 14 months After
Ventriculoperitoneal (VP)Shunt
Journal of NeurosurgeryPediatrics
Mayo Foundation for Medical Education and Research
Shunt Survival
Signs & Symptoms of Shunt Malfunction
• Same as hydrocephalus
• But also signs of infection– Fever– Swelling– Redness– Drainage
Preventative Medicine
• Education• Routine Clinic Follow-up• Surveillance Imaging– Ultrasound– CT scan– MRI
Hydrocephalus in Premature Infants
• VP Shunting is poor option due to:– Small size– Abdomen is poor terminus– Blood in ventricles causes shunt malfunction
Germinal Matrix Hemorrhage
•Grade 1: Hemorrhage confined to the germinal matrix
•Grade 2: Extension into the ventricle but w/o hydrocephalus
•Grade 3: Ventricular Extension with Hydrocephalus
•Grade 4: Parenchymal hemorrhage
Subgaleal Shunt
External Hydrocephalus
Post-Infectious Hydrocephalus
ARACHNOID CYST
• 14 month-old
• Inappropriate head size increase
• Unable to walk
• Abnormal reflexes
• No irritability
• No vomiting
• No excessive somnolence
PRE-OP 6 MONTHS POST-OP
Prognosis
• 6 in 10 will die if untreated– Survivors left with neurologic deficits
• Prompt treatment
• Prognosis dependent on cause of Hydrocephalus:– Infection/ Trauma / Tumors– Aqueductal Stenosis/ Arachnoid cyst
Questions?