Hydrocephalus, also known as "water on the brain," is a condition in which the body has difficulty draining excess fluid from the brain and spinal cord. In its classic form, the disease is characterized by an accumulation of fluid in the brain, causing increased pressure inside the skull. The excess fluid accumulates in the brain's ventricles due to two main reasons: obstruction in the normal flow of cerebrospinal fluid (CSF) and impaired absorption capacity of the CSF.
In the past, hydrocephalus was often considered a hopeless and terminal condition, but significant advances in diagnostic methods and treatment have dramatically improved outcomes for patients with hydrocephalus. In many cases, with timely and proper treatment, individuals affected by hydrocephalus can lead a normal life.
Approximately 1 in 1,000 infants are born with hydrocephalus, and it is more prevalent among preterm babies born before 30 weeks of gestation. There is no difference in disease occurrence between boys and girls. While in many cases, hydrocephalus results from congenital malformations, it can also be caused by infections (such as brain inflammation), brain hemorrhages, tumors, severe head injuries, and complications of other diseases (e.g., meningitis). Therefore, hydrocephalus can develop at any age.
The most prominent sign in infants is an enlarged head circumference, which is characterized by an abnormal increase in head size. This sign is more noticeable in infants due to their open skull sutures. Other symptoms of hydrocephalus may include bulging or tense fontanelles, the infant's inability to look upward, bulging veins in the scalp, thin and shiny scalp, lack of appetite, frequent vomiting, excessive sleepiness, and developmental delays. In older children and adolescents, the symptoms may be less prominent and may manifest as headaches, vomiting, sleep disturbances, lethargy, and blurred vision.
How is hydrocephalus diagnosed?
If a physician identifies the aforementioned symptoms, the disease can be definitively diagnosed using one of the following imaging methods: head ultrasound in infants, CT scan, or MRI.
The treatment of hydrocephalus is typically managed by a neurosurgeon. The surgical procedure involves inserting a thin silicone tube (shunt) into the brain's ventricles, which extends beneath the skin, passes into the abdomen, and drains the excess fluid. The other end of the shunt remains in the brain's ventricles, where the excess fluid accumulates. During the surgery, the neurosurgeon creates small incisions in the scalp and abdomen to position the shunt, and in some cases, an additional incision in the neck is made for a second shunt to be inserted.
In certain cases, hydrocephalus can be treated without a shunt. The procedure is performed using an endoscope, a camera with a light source, and small surgical instruments, which allows the surgeon to navigate inside the brain and create an internal diversion for the cerebrospinal fluid without leaving a shunt in the body.
The length of hospitalization varies depending on the patient's preoperative condition but usually ranges from 2 to 3 days. The stitches from the surgery are usually removed around day 10 post-surgery.