Hydrocephalus Surgery - How It Works, signs, causes & Types.

Hydrocephalus surgery

Hydrocephalus Surgery

A hydrocephalus surgery is a surgical treatment procedure that aims to remove the excess of fluid accumulated in the brain which causes it to swell dangerously. This swelling in the brain due to collection of fluid in it can cause various other neurological and other medical disorders to arise and give rise to other complications in the course of time.

Hydrocephalus (water in the brain) is known to be successfully treated with a hydrocephalus surgery which is successful in draining the excess fluid from the brain and reduce the swelling to its normal size. A prompt hydrocephalus surgery can help relieve present painful symptoms as well as help avoid more complications from arising.

What are the causes of Hydrocephalus?

Hydrocephalus is basically the condition in which the space between the skull and the brain starts to get filled with excessive fluid which in turn puts undue pressure on the different parts of the brain. This may result in a large variety of neurological or physical impairments.

The cerebrospinal fluid (CSF) flows throughout your brain and the spinal cord under normal circumstances. Various conditions may cause the level of CSF in your brain to increase abnormally, such as when:

  • Blockage is seen preventing CSF to flow normally
  • There is an increased disability of the blood vessels to absorb the excess CSF
  • Your brain starts to procedure excess CSF
Excessive fluid buildup in the brain may cause it to swell and may result in severe damage to the brain tissue. There are several reasons why the level of CSF may increase abnormally in the brain of an unborn child.

It could be the result of a congenital (birth) defect such as when the spinal column does not close properly, pregnancy infections such as rubella or due to a genetic abnormality. In older children this condition may arise due to certain central nervous system infections such as meningitis, injuries acquired before, during or after birth, head trauma, bleeding in the brain after a delivery in premature babies as well as tumours of the central nervous system.

Normal pressure hydrocephalus is usually seen in adults where the level of the cerebrospinal fluid (CSF) is abnormally high but the pressure on the brain is not significant. However, even this condition causes the brain to swell and results in impaired functioning. Adults are more prone to develop hydrocephalus if they have any brain-infection such as meningitis, brain injuries, neuro-vascular (brain blood vessel) bleeding (haemorrhage) or brain surgery procedures.

What are the signs and symptoms of Hydrocephalus?

Hydrocephalus can often result in permanent brain damage if not diagnosed at the earliest and given appropriate treatment. The common signs and symptoms of hydrocephalus are known to vary in infants, children and adults. These are the symptoms of hydrocephalus: Infants

  • Bulging/soft spot on the skull
  • Head circumference increases rapidly
  • Eyes are fixed downwards
  • Seizures
  • Vomiting
  • Fussiness
  • Poor diet
  • Lower muscle tone/strength
  • High-pitched cries
  • Change in personality
  • Facial structure changes
  • Eyes get crossed
  • Muscle spasms
  • Headaches
  • Growth is delayed
  • Eating difficulties
  • Constant sleepiness
  • Irritability
  • Loss of bladder control
  • Abnormally large head
  • Loss of coordination
  • Vomiting/nausea
  • Seizures 
Young/middle-aged adults
  • Chronic headaches
  • Coordination loss
  • Bladder problems
  • Walking problems
  • Vision problems
  • Affected memory
  • Concentration problems
Normal Pressure Hydrocephalus (NPH) This type of hydrocephalus is usually seen in adults over the age of 60 years and affects the coordination ability severely and may result in falling without inducing unconsciousness. Other symptoms include:

  • Change in walking style
  • Impaired functioning (memory problems)
  • Bladder control difficulties
  • Bowel controlling difficulties
  • Headaches 

How is Hydrocephalus diagnosed?

If you notice any of the signs and symptoms of hydrocephalus in yourself or your children it is advisable to consult your trusted physician/doctor immediately. The doctor is likely to perform a complete physical examination for other signs and symptoms.

For children the physical examination includes checking for sunken eyes, slow reflexes, bulging fontanel and abnormally large head circumference. An ultrasound may be used to get a closer view of the brain.

The high-frequency sound-waves are helpful in creating a clear image of the brain. MRI (magnetic resonance imaging) scans may be used to search for signs of excess accumulated CSF. CT (computerised tomography) scans can also be used to diagnose hydrocephalus in children as well as adults.

How is a Hydrocephalus Surgery performed?

Surgery is considered to be the best option for treatment of most cases of hydrocephalus, especially the normal pressure hydrocephalus (NPH) which is not causes by any structural abnormality. In most cases, as the underlying cause for fluid accumulation in the brain is unknown, the doctor will likely choose a shunt operation in such cases.

A shunt is composed of a thin surgical tube that is used as an implant in the brain. This shunt is fixed by inserting it into the ventricles to drain away the excess CSF from around the brain. This tube is inserted under the skin and connects to the brain at one end while the other end is adjusted in another part of the body (usually in the lower abdomen).

This shunt is equipped with a valve system that allows releasing the excessive CSF as and when it gets collected in the cranium. The shunt helps drain the fluid from the brain and it is quickly absorbed by the bloodstream.

The pressure setting on the valve can be adjusted according to need. A shunt implant operation is effective in resolving the issue of excess CSF build up in the brain and is not aimed to cure the underlying condition which might be causing the hydrocephalus. However, it can help relieve harmful symptoms caused by hydrocephalus.

The shunt is implanted in the body for an indefinite period of time and is fixed in a way as to be nearly-invisible to others. Another effective method of treatment for hydrocephalus is the new endoscopic third ventriculostomy (ETV).

This procedure does not require implanting a shunt but uses a small hole in the base of the brain to allow the accumulated CSF to drain to the brain’s surface where it can get absorbed naturally. This is a minimally invasive surgical procedure and is ideally considered for obstructive hydrocephalus where the CSF is getting accumulated in the brain due to a blockage.

Hydrocephalus surgery is an important treatment as excess fluid accumulation in the brain for a prolonged period of time gives rise to various other medical disorders and severely painful and disabling conditions which may also turn out to be fatal in nature. Prompt and timely hydrocephalus surgery is highly successful when performed by an experienced and well-trained surgeon.

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