Pathologies Hydrocephalus

Any patient with a suspected diagnosis of hydrocephalus should consult an experienced neurosurgery department as soon as possible. If you have any questions, please contact our team.

Hydrocephalus is a complex syndrome characterized by an alteration in the balance between the formation, circulation, and absorption of cerebrospinal fluid (CSF), which is found in and around the ventricular cavities of the brain and spinal cord. This condition leads to the progressive dilation of the cerebral ventricular cavities, which can lead to an increase in intracranial pressure.
The causes are very diverse, and it is not only associated with congenital anomalies but can also be found in various types of infections, tumors, trauma, and cerebrovascular anomalies, among other conditions, and occurs in all age groups.
Hydrocephalus can be classified according to the time of onset (congenital and acquired), the mechanism that causes it (increased CSF production, impaired CSF circulation, and impaired CSF absorption), and the treatment (communicating and non-communicating). This last classification is the most relevant, as it will determine the best treatment to administer. In the case of communicating hydrocephalus, the patient will require a CSF valve shunt, and in non-communicating hydrocephalus, an endoscopic shunt (tercerventriculostomy).
The clinical presentation of a patient with hydrocephalus varies depending on whether the patient is an infant, a toddler, or an adult. In infants, the symptoms are more subtle and include loss of appetite, non-food vomiting, an enlarged skull (macrocephaly), a full and tense fontanelle, increased venous circulation in the scalp, altered eye movements (sun-like eyes), irritability, and/or increased sleepiness. In children and adults, the condition can present acutely or chronically. It may manifest with headaches, profuse vomiting, irritability, a tendency to sleep unexplained, behavioral disturbances, intellectual impairment, altered eye movements, decreased visual acuity, and/or seizures.
If you suspect hydrocephalus, contact our team immediately.
Regarding diagnostic studies, brain CT is the initial study in patients with a closed skull (children and adults). If there is uncertainty about the etiology of hydrocephalus, to determine whether it is communicating or non-communicating and to guide treatment, brain magnetic resonance imaging (MRI) is the study of choice. In infants, transfontanellar ultrasound of the brain is the first and sometimes only necessary study.

Treatment

For the treatment of hydrocephalus, it is important to determine whether it is caused by another condition that causes an obstruction in CSF circulation (e.g., a brain tumor), since surgical treatment of the primary condition could resolve the hydrocephalus.
If direct treatment of hydrocephalus is necessary, CSF shunt surgery is necessary. If the hydrocephalus is non-communicating (obstructive), the first-line treatment is endoscopic communication (endoscopic third ventriculostomy), a minimally invasive procedure that restores normal CSF circulation.
For communicating hydrocephalus, the treatment is the placement of a valvular CSF shunt. The most commonly used are the ventriculoperitoneal shunt and the ventriculoatrial shunt. These procedures involve placing a catheter in the cerebral lateral ventricle, and tunneling a small valve subcutaneously (i.e., beneath the skin) and the distal catheter to the peritoneal cavity (in the abdomen) or to the cardiac atrium via the jugular vein. The most common complications of valve shunting include shunt dysfunction and infection.

We suggest monitoring the child's progress by a highly experienced neurosurgical team at a referral health center.