Hydrocephalus in Children

Introduction:

Any disruption to the normal production and absorption of cerebrospinal fluid contributes to the accumulation of increased cerebrospinal fluid inside the ventricles - Hydrocephalus.

What causes hydrocephalus in children?

Several conditions can cause obstructed flow of cerebrospinal fluid, including:

• Congenital aqueductal stenosis

• Chiari malformation is an example of an inborn nervous system irregularity.

• Spina bifida and other neural tube abnormalities

• Syndrome of Dandy-Walker (a congenital brain malformation involving the cerebellum and the fluid-filled spaces around it)

• Cysts of the arachnoid

• Meningitis is a kind of infection.

• Premature newborns might suffer from intraventricular hemorrhage.

• A brain tumor in the rear of the brain (posterior fossa)

• A head injury

Signs/ Symptoms:

Symptoms may manifest differently in each child. They may include the following:

• A soft region on the top of the baby's head that is plump or bulging (fontanel)

• expanding head size (circumference).

• Seizures

• When looking forward, bulging eyes and inability to glance up

• Scalp veins that are visible

• Irritability

• High-pitched scream

• Inadequate nutrition

• Vomiting as a projectile

• Being sleepy or less alert than normal

• Delays in development

Hydrocephalus is usually identified by the child's parents or pediatrician when the child's head begins to swell and grow fast. In some cases, a prenatal ultrasonography (this test creates a picture of the interior of the body using sound waves) can reveal the size of the ventricles throughout pregnancy. It can even be employed after birth as long as the anterior fontanelle is open. Also, an MRI scan is employed which can detect hydrocephalus in a developing fetus. A comprehensive physical examination and complete family and patient history is also derived to help land into the right treatment. Imaging examinations, including MRI scans, are critical for diagnosis and may need to be repeated in order to detect any advancement of the hydrocephalus.

A multidisciplinary team approach is recommended when deciding on a course of therapy for a kid with hydrocephalus. The treatment plan is developed by the panel of neurosurgeons, neurologists, pediatric ophthalmologists, radiologists, and others. Hydrocephalus can be treated in most cases, but the kid may require continuing care for the rest of their life.

Based on the child’s symptoms, age, and overall health, the treatment will be determined. It will also be determined by the gravity of the situation. The purpose of the treatment is to relieve the pressure within cranial vault. This can be accomplished by partly emptying the Cerebrospinal fluid. This can be done with medicines, but majorly a surgical intervention is needed.

Shunt:

A shunt, a short piece of silicone tubing surgically implanted within the body to circumvent a blockage or otherwise improve the flow of cerebrospinal fluid, is the most frequent hydrocephalus therapy. The shunt permits fluid to flow in just one direction via it. A valve system controls the flow and provides a reservoir of cerebrospinal fluid that can be checked often to ensure that the shunt is operating well and that no symptoms of infection are present. We usually prefer shunt with programmable valve for young children with hydrocephalus.

Endoscopic Procedures:

This alternative to shunting can treat some kinds of hydrocephalus in selected people. To circumvent the obstruction and restore a more normal flow of cerebrospinal fluid, the surgeon employs an endoscopic technique and cuts a small hole in the afflicted ventricle.

Complications:

Surgery and shunts can sometimes create complications. Complications might include infection or bleeding. A faulty shunt may drain too much or too little fluid. It is important to learn from the child's health care team on how to take care at home after surgery and also to look out for any emergency symptoms. 

Conclusion:

It is important to recognize hydrocephalus at young age because delaying the treatment can affect the development of brain. Appropriate investigations and treatment for hydrocephalus has to been initiated at the earliest as it impacts in normal brain development once the pressure is reduced and CSF is relieved. If the treatment is delayed and the brain development is complete, the child may suffer irreversible damage (mentally retarded) even after treating hydrocephalus.