What is Hydrocephalus?
Hydrocephalus is a disease that can occur at any age, including in the womb. It is also known as water retention in the brain. Hydrocephalus is a combination of the words hydro=water and cephaly=head. It means "head full of water" in Greek.
Hydrocephalus is caused by the accumulation of cerebrospinal fluid (CSF, Cerebrospinal Fluid) in the cranial cavity, brain ventriclesüls and cavities above normal levels, and in this disease there is usually head enlargement in the childhood age group.
Cerebrospinal fluid should not be thought of as normal water. It has vital functions, such as protecting the brain in the event of a severe stroke, which can adversely affect our brain. This fluid contains nourishing nutrients as well as those found in our blood. The brain retains about half a liter of CSF per day and this CSF is absorbed by the brain. In other words, CSF goes through a continuous process of production, circulation and absorption in our body. It circulates in the cavities of the brain and between the sheaths lining the brain and spinal cord. Fluid accumulation may occur when the production of CSF is above normal, there is an absorption problem, and there is a problem in circulation as a result of stenosis or obstruction in the channels where the fluid circulates. The buildup of this fluid causes pressure on the brain, and this pressure is known to cause a wide range of brain damage. Various types of brain damage can lead to developmental, physical and mental impairments.
It is not a disease that can be cured spontaneously or treated with medication under the supervision of a physician, and the only çösolution üis surgery. After the diagnosis of the disease, surgical treatment should be performed at the earliest possible time. In cases where treatment is delayed or not performed at all, the disease can be fatal. It can be diagnosed even in the womb with various radiological techniques and early diagnosis is very important.
The disease can be seen at any age, starting from infancy in the womb to old age. However, the symptoms of this disease are different in every age range.
What Causes Hydrocephalus?
Sometimes the cause of hydrocephalus is not clearly understood. The causes of hydrocephalus can be divided into 2 types: congenital, which means congenital, or acquired, which means acquired.
Causes of congenital hydrocephalus: A baby can be born with hydrocephalus if there is a problem with the flow of CSF. This problem can also be seen in premature babies, and some premature babies may even develop brain hemorrhage.
- Some health problems such as spina bifida
- Some mutations associated with the X chromosome
- Some rare genetic disorders (such as Dandy Walker malformation)
- Sacs filled with fluid between the brain or spinal cord and the arachnoid membrane, i.e. Arachnoid cysts
Ço causes of hydrocephalus in children and adults: Hydrocephalus affecting these ço children or adults is usually caused by disease, trauma or injury affecting the brain. It is called acquired hydrocephalus.
- Infections in the membrane that covers the brain and spinal cord (such as meningitis)
- Tümörs that occur in the brain
- Stroke
- Traumas and injuries to the head from certain causes
- Blood clots in the brain, a condition called vein thrombosis
- Brain hemorrhage conditions seen inside the brain
- Congenital stenosis of the canals through which the cerebrospinal fluid circulates can sometimes be symptomatic in later life.
Causes of hydrocephalus in the elderly: Hydrocephalus can develop in the elderly as a result of brain damage, cerebral hemorrhage, and certain infections. It can develop in connection with chronic conditions that negatively affect blood flow, such as diabetes, heart disease or high cholesterol. These conditions are factors that may cause hydrocephalus, but the exact cause is unknown. In these patients, we can usually observe hydrocephalus with normal pressure.
Symptoms of Hydrocephalus
Hydrocephalus can produce different symptoms depending on the type of hydrocephalus and the age at which the disease is diagnosed.
Symptoms of congenital hydrocephalus:
- The head is larger than normal due to blisters,
- Skin so thin and shiny that the veins are easy to see
- Bloating or tightness in the fontanel (the soft böl;lge on the baby's head) due to blistering
- Wide gaps in the skull
- Disorder and imbalance in diet
- Nervousness
- Vomiting
- Nöbetting (Epilepsy, epileptic seizure)
- Sürecurrent drowsiness
- Stiffness and spasms in the muscles of the feet and legs
- Slipping of the eyes, vision problems
Symptoms of hydrocephalus in adults or children:
- Pain in the head (The cerebral fluid does not drain well due to prolonged lying in the lying position. For this reason, people may feel more severe headaches when they wake up in the morning. Constant sitting can also increase headaches, and these headaches can become persistent as the disease progresses and is left untreated.
- Neck pain
- Feeling sick, tired and sluggish
- Frequent drowsiness (in advanced cases, even coma may occur)
- Mental fogginess and frequent confusion
- Vision problems, often blurred or fuzzy vision
- Difficulty in eating and drinking
- Inability to urinate and defecate
- Ço children's short, high-pitched cries
- Changes in facial appearance with the change in head size, as well as changes in facial features
- Ço developmental delay in children
- Slowing down and limiting movements
- Moodiness and moods that are irritable and uncontrollable
- Nöbetting (Epilepsy, epileptic seizure)
Signs of hydrocephalus with normal pressure:
It usually occurs in adults older than 60 years of age. The main symptom of this condition is sudden falls without loss of consciousness.
- Disturbance in eating and drinking, inability to do things comfortably (Typical sweat magnet sensation in the sweat)
- Problems with memory due to impaired mental functions, forgetfulness
- Pain in the head
- Incontinence of urine or feces
How is Hydrocephalus Diagnosed?
Nöroradiologic techniques, which have developed thanks to the advancement of technology and medicine, are used for diagnosis. These techniques include MR imaging (CSF flow MRI) and Computed Tomography (CT) . Thanks to these techniques, disease-related enlargement of the brain cavities and changes in brain tissue can be detected and the diagnosis of hydrocephalus can be made with certainty by combining the patient's examination with the symptoms observed.
This disease can also be found in babies in the womb before birth. MRI and ultrasonography are techniques used to determine the brain development of the baby in the womb and changes in the brain cavities and to monitor these changes. With the MRI procedure performed after the birth of the baby, the cause of the hydrocephalus is determined.
How to Treat Hydrocephalus
As with other diseases, early diagnosis is very important in hydrocephalus. Treatment with medication is not possible in hydrocephalus. The only treatment method is surgical interventions. Only neurosurgeons and neurosurgeons can perform these surgical interventions. There are many methods for surgical interventions and the best method is chosen according to the factors that cause hydrocephalus.
If the cause of hydrocephalus is improper CSF circulation and the reason for this is obstruction in the circulatory channels, a surgical method should be chosen to remove the obstruction. The cause of these blockages may be conditions such as tümör, cysts. In cases where the obstruction cannot be eliminated, the circulatory channels of CSF in the brain can be replaced by surgical interventions.
Shunt surgery
In general, the circulation of this fluid cannot be restored to its former healthy state, and it is transferred to a cavity in the vücut. Generally, it is preferred to transfer the cerebrospinal fluid to a cavity in the abdomen or heart where it can be easily absorbed. For this transfer, a thin, long, elastic, silicone tubing known as a "shunt" is used. This process needs to be unidirectional and at a controlled speed. This requires a pump and a thin tube located under the scalp. This process helps to increase the pressure inside the brain. Considering that the fluid in the brain is being pumped every day, it is clear that this system needs to be constantly maintained. The parts of this system are under the skin but can be felt by touch or during a physical examination. In infants, it can be seen from the outside. The shunt does not need a power source such as a battery. If the necessary controls are made after this procedure, patients can continue their lives without any problems.
Endoscopic Ventricülostomy
After the development of endoscopic (camera-based) systems, it is now the treatment of choice for suitable patients. There is no need for a shunt system in this method known as endoscopic üüüncüncü ventric ülostomy (opening a new pathway for the fluid to circulate) and aquaducttoplasty (opening the blocked area). In addition, the endoscopic method may be preferred in patients who have a shunt inserted and have recurrent problems such as recurrent shunt blockage, and in patients who have had the shunt removed due to infection problems.
The operation is performed through a small 1-2 cm long skin incision, through a small hole in the skull, through which an endoscope (camera) is inserted into the ventricle. A pathway is opened here for the circulation of spinal fluid to the lower part of the ventricle. Thus, the accumulated fluid starts to leave from here. The surgery takes approximately 1 hour. The patient is discharged the next day.
This method, which is more advantageous than shunt surgery in appropriate patients, does not involve any plastic tubing or system placed in the viscera. There is less risk of infection. Problems such as shunt blockage and maladaptation are not seen. In addition, there are some risks of surgery. In rare cases, the aperture, which is surgically opened and allows the fluid to drain, may close again spontaneously, and the visual nerves may be affected.
In general, this method is not preferred for babies under 1 year of age.
If a diagnosis is made in the womb, the baby should be delivered as soon as possible and the necessary surgical intervention for the disease should be performed as soon as possible.
Hydrocephalus is a disease that can be fatal if diagnosed too late. For this reason, do not neglect to have your check-ups at the nearest health institution in case of symptoms.
