Hydro What???

What is Hydrocephalus I hear you ask well the term hydrocephalus is from the Greek words “hydro” meaning water and “cephalus” meaning head. As the name implies, it is a condition in which the primary characteristic is excessive accumulation of fluid in the brain. Although hydrocephalus was once known as “water on the brain,” the “water” is actually cerebrospinal fluid (CSF) — a clear fluid that surrounds the brain and spinal cord.

The excessive accumulation of CSF results in an abnormal widening of spaces in the brain called ventricles. This widening creates potentially harmful pressure on the tissues of the brain.

The ventricular system is made up of four ventricles connected by narrow passages. Normally, CSF flows through the ventricles, exits into cisterns (closed spaces that serve as reservoirs) at the base of the brain, bathes the surfaces of the brain and spinal cord, and then reabsorbs into the bloodstream.

CSF has three important life-sustaining functions which are to keep the brain tissue buoyant, acting as a cushion or “shock absorber”, to act as the vehicle for delivering nutrients to the brain and removing waste; and to flow between the cranium and spine and compensate for changes in intracranial blood volume (the amount of blood within the brain).

What is the current treatment?

Hydrocephalus is most often treated by surgically inserting a shunt system. This system diverts the flow of CSF to another area of the body where it can be absorbed.

A shunt is a flexible but sturdy plastic tube, a catheter, and a valve. One end of the catheter is placed within a ventricle inside the brain or in the CSF outside the spinal cord. The other end of the catheter is commonly placed within the abdominal cavity, but may also be placed at other sites in the body such as the heart or areas around the lung. A valve located along the catheter maintains one-way flow and regulates the rate of CSF flow.

Shunts are not perfect and can malfunction. Complications may include mechanical failure, infections, obstructions, and the need to lengthen or replace the catheter. Generally, shunt systems require monitoring and regular medical follow up. When complications occur, subsequent surgery to replace the failed part or the entire shunt system may be needed.

Some complications can lead to other problems such as overdraining or underdraining. Overdraining is when the shunt allows CSF to drain from the ventricles more quickly than it is produced. Overdraining can cause the ventricles to collapse, tearing blood vessels and causing headache, hemorrhage , or slit-like ventricles (slit ventricle syndrome). Underdraining occurs when CSF is not removed quickly enough and the symptoms of hydrocephalus recur. In addition to the common symptoms of hydrocephalus, infections from a shunt may also produce symptoms such as a low-grade fever, soreness of the neck or shoulder muscles, and redness or tenderness along the shunt tract. When there is reason to suspect that a shunt system is not functioning properly (for example, if the symptoms of hydrocephalus return), medical attention should be sought immediately.

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