Brain Surgery

Hydrocephalus

Overview

Hydrocephalus is the accumulation of cerebrospinal fluid (CSF) within the brain – the problem colloquially known as “water on the brain” – with the effect of causing swelling in the brain and a broad range of physical consequences.

CSF, a clear fluid, circulates among the four ventricles within the brain and through the spinal column, providing nourishment and protecting those areas from injury. Normally, it’s absorbed into the blood and eliminated through the kidneys.

If a blockage of some kind occurs, the fluid backs up, causing the ventricles to enlarge and press against key areas of the brain. Nerve connections become stretched and distorted, causing problems ranging from headache and nausea to mental impairment.

Risk Factors

Although hydrocephalus can affect patients at any age, it’s most common in infants and people over age 60 (With pediatrics a specialty in itself, PRH’s neurosurgeons focus on the problem in adults). Hydrocephalus can be congenital or acquired following such events as stroke, trauma or infection. A variation called normal pressure hydrocephalus, which most commonly affects the elderly, develops chronically over time, often without obvious cause – idiopathic normal pressure hydrocephalus (INPH).

Symptoms

Symptoms vary with age and progression of the disorder. Among infants the most obvious is an unusually large head or a rapid increase in head size. Adults may experience headache, nausea and vomiting, lethargy, problems with eye movements, coordination and balance difficulties, gait disturbance, urinary incontinence, personality changes and memory loss, and other cognitive problems. INPH patients most commonly experience the triad of gait disturbance, urinary incontinence and cognitive impairment.

Diagnosis

Diagnosis begins with a neurological evaluation and brain imaging procedures, including ultrasound, CT and MRI scanning and pressure monitoring techniques using PRH’s fiberoptic monitoring technology, the camino.

Treatment Options

While in some cases treatment may involve surgery to correct the cause of the problem, most cases – especially INPH cases – are treated with the surgical placement of a shunt, a silicone tube about the thickness of a strand of linguine, to divert excess fluid into other parts of the body. Often, the shunt runs down the neck underneath the skin to the abdominal cavity, where the fluid ends up being excreted through the urinary system.

For More Information:

National Institute of Neurological Disorders and Stroke National Institutes of Health
http://www.ninds.nih.gov/

The Hydrocephalus Association
www.hydroassoc.org

National Hydrocephalus Foundation
www.nhfonline.org