HYDROCEPHALUS
Frequently Asked Questions
(FAQ)
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1_ What is it?
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Normally within the brain there are some
cavities named ventricles, where a liquid known as Cerebrospinal
Fluid (CSF) is produced. The purpose of this is to protect the brain
and spinal cord, acting as a shock absorber. It also carries away
disposed materials. The CSF circulates from the ventricles towards
a space that exists between the brain and the membranes (meninges)
that surround it, from where it is "eliminated", into the
blood stream.
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When for any reason the volume
of CSF increases within the head and the brain, the size of the ventricles
increases and this is known as Hydrocephalus. This translates into
an increase of head pressure, and therefore there is suffering of
the brain.
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2_ How frequent is Hydrocephalus?
It is found in 1 to 3 of every 1000
born children.
3_ When does Hydrocephalus
appear ?
1- When there is over production
of CSF.
2- When there is a blocking in the paths of the
CSF circulation.
3- When not all the CSF produced is "eliminated".
4_ What can cause Hydrocephalus ?
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Congenital defects in the developing
of the CSF circulation pathways is the most frequent cause.
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It can also be caused by other
diseases affecting the brain, like meningitis, hemorrhage or tumors
that block the CSF circulation.
5_ How is Hydrocephalus
detected in a child ?
In children under 1 year of age the
head can have an accelerated and disproportionate growth and the fontanel
could bulge. This is why in a routine medical check the doctor has to
measure the head and be certain that the size and growth rhythm are adequate.
In older children the symptoms could be headache, vomit, double vision,
walking problems or tiredness.
6_ What does the doctor
do when he suspects that a child has Hydrocephalus ?
First is has to be corroborated with
special tests as the Ultrasound or Computerized Axial Tomography (CT scanner).
If the diagnosis is confirmed, he will try to Determine the cause.
7_ How is Hydrocephalus
treated ?
The objective of the treatment is
to diminish the volume of accumulated CSF and this is done by means of
a shunt.
8_ What is a shunt
?
It is a drainage system which will
transport the excess of CSF collected in the head to other parts of the
body where it can be reabsorbed. The most frequent places are the abdomen
and the heart.
9_ How does a shunt
work ?
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Each shunt has 3 parts:
1- Ventricular catheter: a small flexible
tube which goes in the brain, in one of the cavities where the CSF
is being retained.
2- Reservoir : a small pump which regulates
the amount of fluid that goes out. Through this the doctor can also
check the working state of the shunt, as well as take CSF samples,
when necessary, with a needle.
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| 3- Distal catheter: another flexible tube
that will take the fluid to the place where it is going to be absorbed.
It is usually left with sufficient length, thinking in the child's
growth..
The shunts regulates the draining pressure.
There are different levels of pressure, as high, medium and low.
There are also some differences in the design but the means is always
the same.
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10_ How do you take
care of a child with a shunt ?
- Do not manipulate the shunt unless
indicated by the doctor.
- Do not leave a small child lying
on the side of the shunt, as the pressure could weaken the skin. Once
the child turns on his own he will move the head freely to where he feels
more comfortable.
- Frequently check for any redness or secretion
on the skin over the shunt.
- Check the integrity of the skin over the shunt,
wounds or scratches may conduct to infection.
- Be punctual with the normal pediatric checks.
- Check that the fontanel is leveled or depressed
below the level of the bone. However, when the baby cries it could
bulge.
- Observe for symptoms of shunt malfunction.
11_ What are the symptoms of shunt
malfunction ?
One or some of these are:
- persistent headache
- vomiting without diarrhea
- double vision
- irritability
- tiredness
- fits
- bulging of the fontanel, if this is still
open.
12_ Can shunt malfunction be prevented
or detected beforehand ?
No. Unfortunately, it can happen
at any moment, or never.
13_ What causes a
shunt malfunction ?
Remember that a shunt is a "foreign
body" within the patient and the tubing is made from synthetic materials;
therefore, malfunction could be due to one of the following:
- it's blocked with byproducts of the CSF
- some of its components
get disconnected
- it breaks (usually the distal end)
- any of the catheters come out of their place
- the shunt drains less fluid than it is supposed
to
- it gets infected
14_ What do you do when you suspect
that a shunt is not working properly ?
Take the child to the doctor, he will
determine if the symptoms are due to shunt malfunction or to other disease.
If there is a malfunction probably it will need to be corrected surgically.
15_ Can a child with
Hydrocephalus lead a normal life ?
Once Hydrocephalus is compensated
with the use of a shunt the child could have a normal developing. However,
you have to consider that the origin of it could have left damages in
the brain. The promptness of the diagnosis is also very important, the
earlier the shunt is placed, the better the prognosis.
If there is not an associated disease
and depending on the child's condition, he could go to school, practice
sports or arts, the same as any child of the same age, there is no reason
for segregation.
16_ How often does
a shunt have to be replaced ?
In about 6 of every 10 children, at
some stage in their lives a shunt revision or change will have to be made.
As long as a shunt is working properly
it is not necessary to change it. Sometimes the distal catheter breaks
with the child's growth and if the shunt is being needed malfunction symptoms
will appear. Other times, infection could account for a shunt replacement.
17_ Can a child stop
needing a shunt ?
Sometimes it happens, the CSF blocking
disappears. However this could be overlooked and there is no problem for
the child and it is not necessary to operate on him only to remove the
shunt. As far as there are no complications the shunt can stay in its
place forever and produce no harm.
18_ What do parents
have to know about the shunt placed on their child ?
- The day the shunt was placed.
- The kind or type of shunt.
- The opening pressure of the shunt.
19_ Are there any
options other than a shunt ?
20_ What is a Third
Ventricular Cysternostomy ?
| In some kinds of Hydrocephalus
known as "non communicating" (because there is no communication
between the ventricles and the spaces around the brain, where the
CSF is absorbed), a Third Ventricular Cisternostomy can be done. This
operation is done with an endoscope (instrument connected to a video
camera which allows to see the depths of the brain) and instruments
passed through it to make an opening in the floor of the third ventricle,
which will allow the passage of CSF to a place where it can be absorbed
(subarachnoid space).
If this procedure is indicated and is effective,
the patient could live without a shunt.
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