Hydrocephalus treatment is surgical, generally creating various types of cerebral shunts. It involves the placement of a ventricular catheter (a tube made of silastic), into the cerebral ventricles to bypass the flow obstruction/malfunctioning arachnoidal granulations and drain the excess fluid into other body cavities, from where it can be resorbed. Most shunts drain the fluid into the peritoneal cavity (ventriculo-peritoneal shunt), but alternative sites include the right atrium (ventriculo-atrial shunt), pleural cavity (ventriculo-pleural shunt), and gallbladder. A shunt system can also be placed in the lumbar space of the spine and have the CSF redirected to the peritoneal cavity (Lumbar-peritoneal shunt). An alternative treatment for obstructive hydrocephalus in selected patients is the endoscopic third ventriculostomy (ETV), whereby a surgically created opening in the floor of the third ventricle allows the CSF to flow directly to the basal cisterns, thereby shortcutting any obstruction, as in aqueductal stenosis. This may or may not be appropriate based on individual anatomy.
Examples of possible complications include shunt malfunction, shunt failure, and shunt infection, along with infection of the shunt tract following surgery (the most common reason for shunt failure is infection of the shunt tract). Although a shunt generally works well, it may stop working if it disconnects, becomes blocked (clogged), infected, or it is outgrown. If this happens the cerebrospinal fluid will begin to accumulate again and a number of physical symptoms will develop (headaches, nausea, vomiting, photophobia/light sensitivity), some extremely serious, like seizures. The shunt failure rate is also relatively high (of the 40,000 surgeries performed annually to treat hydrocephalus, only 30% are a patient’s first surgery) and it is not uncommon for patients to have multiple shunt revisions within their lifetime.
The diagnosis of cerebrospinal fluid buildup is complex and requires specialist expertise.
Another complication can occur when CSF drains more rapidly than it is produced by the choroid plexus, causing symptoms -listlessness, severe headaches, irritability, light sensitivity, auditory hyperesthesia (sound sensitivity), nausea, vomiting, dizziness, vertigo, migraines, seizures, a change in personality, weakness in the arms or legs, strabismus, and double vision – to appear when the patient is vertical. If the patient lies down, the symptoms usually vanish in a short amount of time. A CT scan may or may not show any change in ventricle size, particularly if the patient has a history of slit-like ventricles. Difficulty in diagnosing overdrainage can make treatment of this complication particularly frustrating for patients and their families.
Resistance to traditional analgesic pharmacological therapy may also be a sign of shunt overdrainage or failure. Diagnosis of the particular complication usually depends on when the symptoms appear – that is, whether symptoms occur when the patient is upright or in a prone position, with the head at roughly the same level as the feet.
Saturday, Apr 13, 2013 AFP
By Arindam Dey
JIRANIA KHOLA, India – A desperate Indian father whose young child suffers from a condition that caused her head to swell up to an enormous size said Saturday he is praying for a “miracle” to save her life.
Eighteen-month-old Roona Begum was diagnosed with hydrocephalus, in which cerebrospinal fluid builds up in the brain, just weeks after her birth in a government-run hospital in remote Tripura state in northeast India.
The potentially fatal illness has caused Roona’s head to swell to a circumference of 91-centimetres (36-inches), putting pressure on her brain.
Her father, Abdul Rahman, 18, who lives in a mud hut with his family in the village of Jirania Khola, told AFP he prays for “a miracle” that will save his only child.
“Day by day, I saw her head growing too big after she was born,” said the illiterate labourer who works in a brick-making factory.
Doctors told him to go to a specialist hospital in a big city such as Kolkata in eastern India to get medical help but Rahman, who earns 150 rupees ($2.75) a day working in the brick plant, said he does not have the money to take her.
“It’s very difficult to watch her in pain. I pray several times a day for a miracle – for something to make my child better,” he said.
The US government’s National Institute of Neurological Disorders and Stroke estimates about one in every 500 children suffers from hydrocephalus.
The most common treatment involves the surgical insertion of a shunt system to drain cerebrospinal fluid away from the brain and towards another part of the body where it can be easily absorbed into the bloodstream.
Cases like Roona’s, where the head has doubled in size in a relatively short span of time, are extremely rare, according to leading Indian neurosurgeon Sandeep Vaishya.
“It’s difficult to assess the situation without seeing the patient, but a surgery, even at this late stage, would give her brain the best chance it has to grow and develop normally,” Vaishya told AFP.
Vaishya, who is the head of neurosurgery at the privately run Fortis flagship hospital in Gurgaon, a satellite city of the national capital Delhi, said that surgeries to treat hydrocephalus cases are “not particularly risky.”
Although the cost differs from case to case, he estimated that a complex surgery like this one would cost about 125,000 rupees ($2,300) and require a three-day hospital stay.
Roona now is confined to her bed and unable to move her head but she is a playful child, quick to smile and giggle and is able to move her limbs, according to her father.
She has outlived an initial prognosis by doctors that she would survive only two months.
But her mother, Fatema Khatun, 25, says the little girl’s health is getting worse and that she urgently needs help.
“She is deteriorating. She eats less and less, vomits often and I can see that she is getting thinner,” Khatun told AFP.