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As a parent, nothing is more frightening than a sick child. When that sickness involves the brain, it becomes terrifying. It is estimated that 1 in 500 children will be diagnosed with hydrocephalus, a condition causing excessive fluid around the brain and spinal cord. Whether your child was born with hydrocephalus or developed it later, please join Dr. Leslie Satchivi as he discusses this condition, how to treat it and what it means for your child developmentally.
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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?
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