Hydrocephalus in ChildrenLeslie Acakpo-Satchivi, MD-PhD, Neurosurgery

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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?