Hydrocephalus treatment in adults

hydrocephalus treatment in Iran

Is hydrocephalus genetic?

Hydrocephalus treatment in adults

 What are the Hydrocephalus causes?

Hydrocephalus Risk factors

What are the long-term effects of hydrocephalus?

What are the Hydrocephalus symptoms and signs?

How is hydrocephalus diagnosed?

Can a person with hydrocephalus live a normal life?

Can hydrocephalus go away?

Is hydrocephalus can be cured

 

Hydrocephalus

The term hydrocephalus is derived from two words: "hydro" meaning water, and "Cephalus" referring to the head.
Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles (fluid-containing cavities) of the brain and may increase pressure within the head. Although hydrocephalus is often described as "water on the brain," the "water" is actually CSF, a clear fluid surrounding the brain and spinal cord. CSF has three crucial functions: 1) it acts as a "shock absorber" for the brain and spinal cord; 2) it acts as a vehicle for delivering nutrients to the brain and removing waste; and 3) it flows between the cranium and spine to regulate changes in pressure within the brain. Hydrocephalus can occur at any age, but is most common in infants and adults age 60 and older.

 

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Types of hydrocephalus

  • Congenital hydrocephalus

Approximately 1 in every 500 American babies are born with hydrocephalus. It may be caused by an infection in the mother during pregnancy, such as rubella or mumps, or a birth defect, such as spina bifida. It is one of the most common developmental disabilities, more common than Down syndrome or deafness.

  • Acquired hydrocephalus

This develops after birth, usually after a stroke, brain tumor, meningitis, or as a result of a serious head injury.

  • Communicating hydrocephalus

This type of hydrocephalus occurs when the CSF becomes blocked after leaving the ventricles. It is called "communicating" because CSF can still flow between the brain's ventricles.

  • Non-communicating hydrocephalus

Also called obstructive hydrocephalus, non-communicating hydrocephalus occurs when the thin connections between the ventricles become blocked.

  • Normal pressure hydrocephalus

This only affects people aged 50 or older. It may develop after stroke, injury, infection, surgery, or hemorrhage. However, in many cases, doctors do not know why it occurred.

  • Hydrocephalus ex-vacuo

This type occurs after stroke, traumatic brain injury, or degenerative diseases. As brain tissue shrinks, the ventricles of the brain become larger.

 

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Is hydrocephalus genetic?

It is thought that congenital hydrocephalus can be caused by genetic defects that can be passed from one or both parents to a child, but the direct links to hereditary disorders are still being investigated. However, experts have found a connection between a rare genetic disorder called L1 syndrome and hydrocephalus.

Hydrocephalus treatment in adults

The most common treatment for hydrocephalus is the surgical insertion of a drainage system, called a shunt. It consists of a long, flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate.

 What are the Hydrocephalus causes?

Hydrocephalus is caused by an imbalance between how much cerebrospinal fluid is produced and how much is absorbed into the bloodstream.

Cerebrospinal fluid is produced by tissues lining the ventricles of the brain. It flows through the ventricles by way of interconnecting channels. The fluid eventually flows into spaces around the brain and spinal column. It's absorbed primarily by blood vessels in tissues near the base of the brain.

Cerebrospinal fluid plays an important role in brain function by:

  • Keeping the brain buoyant, allowing the relatively heavy brain to float within the skull
  • Cushioning the brain to prevent injury
  • Removing waste products of the brain's metabolism
  • Flowing back and forth between the brain cavity and spinal column to maintain a constant pressure within the brain compensating for changes in blood pressure in the brain

Excess cerebrospinal fluid in the ventricles occurs for one of the following reasons:

  • Obstruction. The most common problem is a partial obstruction of the normal flow of cerebrospinal fluid, either from one ventricle to another or from the ventricles to other spaces around the brain.
  • Poor absorption. Less common is a problem with the mechanisms that enable the blood vessels to absorb cerebrospinal fluid. This is often related to inflammation of brain tissues from disease or injury.
  • Overproduction. Rarely, cerebrospinal fluid is created more quickly than it can be absorbed.
  •  

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Hydrocephalus Risk factors

The following factors increase the risk of hydrocephalus:

  • Premature birth: Infants born preterm have a higher risk of intraventricular hemorrhage, or bleeding within the ventricles of the brain, which may result in hydrocephalus.
  • Problems during pregnancy: An infection in the uterus during pregnancy increases the risk of hydrocephalus in the developing fetus
  • Problems with fetal development: Examples include incomplete closure of the spinal column.

Other conditions that increase the risk include:

  • lesion and tumors of the spinal cord or brain
  • infections of the nervous system
  • bleeding in the brain
  • severe head injury

What are the long-term effects of hydrocephalus?

Congenital hydrocephalus carries the risk of long-term mental and physical disabilities as a result of permanent brain damage. if hydrocephalus left untreated can cause the head to steadily grow in size, convulsions, and brain damage. Hydrocephalus can be fatal if left untreated. Other symptoms include headaches, vomiting, blurred vision, cognitive problems, and walking difficulties.

 

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What are the Hydrocephalus symptoms and signs?

symptoms depend on the type of hydrocephalus and the age of the person affected.

 Hydrocephalus from birth

Babies born with hydrocephalus (congenital) often have distinctive physical features.

These can include:

  • an unusually large head
  • a thin and shiny scalp with easily visible veins
  • a bulging or tense fontanelle (the soft spot on top of a baby's head)
  • downward looking eyes

Congenital hydrocephalus can also cause:

  • poor feeding
  • irritability
  • vomiting
  • sleepiness
  • muscle stiffness and spasms in your baby's lower limbs

Congenital hydrocephalus is sometimes picked up before a baby is born during an ultrasound scan.

However, it's usually diagnosed soon after birth during the newborn physical examination. The problem may be suspected if your baby's head is larger than normal.

Hydrocephalus that develops in adults or children

Hydrocephalus that develops in adults or children (acquired) can cause headaches.

The headache may be worse when you wake up in the morning because the fluid in your brain does not drain so well while you're lying down and may have built up overnight.

Sitting up for a while may improve your headache. However, as the condition progresses, the headaches may become continuous.

Other symptoms of acquired hydrocephalus include:

  • neck pain
  • feeling sick
  • being sick – this may be worse in the morning
  • sleepiness – can progress to a coma
  • changes in your mental state, such as confusion
  • blurred vision or double vision
  • difficulty walking
  • an inability to control your bladder (urinary incontinence) and, in some cases, your bowel (bowel incontinence)

Normal pressure hydrocephalus (NPH)

The symptoms of normal pressure hydrocephalus (NPH) tend to affect older people and usually develop slowly, over the course of many months or years.

NPH has 3 sets of distinctive symptoms. It affects:

  • how you walk (mobility)
  • the urinary system
  • mental abilities

See your GP if you have any of the symptoms described below.

The first noticeable symptom of NPH is a change in how you walk (your gait). You may find it increasingly difficult to take the first step when you want to start walking.

Some people have described it as feeling as though they're frozen to the spot. You may also shuffle rather than take proper steps.

As the condition progresses, you may become increasingly unsteady on your feet and be more likely to fall, particularly when turning.

Urinary symptoms

The change in the way you walk is often followed by bouts of urinary incontinence, which may include symptoms such as:

  • a frequent need to urinate
  • an urgent need to urinate
  • loss of bladder control

Mental abilities

The normal thinking process also starts to slow down. This can take the form of:

  • being slow to respond to questions
  • reacting slowly to situations
  • being slow to process information

These symptoms may indicate that you have mild dementia. They should start to improve when NPH is treated.

How is hydrocephalus diagnosed?

The most common initial diagnostic test to determine hydrocephalus at any age is an image of the brain using CT or MRI to identify if the ventricles or spaces within the brain are enlarged. More tests are often performed in adults in order to diagnosis the condition.

 

 

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Can a person with hydrocephalus live a normal life?

Hydrocephalus is a chronic condition. It can be controlled, but usually not cured, Hydrocephalus can occur at any age, but is most common in infants and adults age 60 and older. Left untreated, hydrocephalus can cause severe disability, even death. Hydrocephalus occurs when excessive cerebrospinal fluid accumulates in the brain. without treatment, hydrocephalus results in compromised mental functioning, visual disturbances, walking difficulty, incontinence, and reduced conscious state.

 

Can hydrocephalus go away?

 There is currently no known way to prevent or cure hydrocephalus and the only treatment option today requires brain surgery. With early detection and appropriate intervention of hydrocephalus, the future for many is promising, Hydrocephalus is a chronic condition. It can be controlled, but usually not cured.  With appropriate early treatment, however, many people with hydrocephalus lead normal lives with few limitations.

 

Is hydrocephalus can be cured?

There is currently no known way to prevent or cure hydrocephalus and the only treatment option today requires brain surgery. With early detection and appropriate intervention of hydrocephalus, the future for many is promising. Recent research is advancing knowledge and moving us closer to a cure. The most common treatment for hydrocephalus is the surgical insertion of a drainage system.

 

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Hydrocephalus treatment options

The standard treatment for hydrocephalus is to implant a shunt. The shunt drains and redirects excess cerebrospinal fluid from the brain’s ventricles to another part of the body. Shunts, like those available from Medtronic, can help children and adults with hydrocephalus lead full, active lives.

 

Hydrocephalus treatment 

Hydrocephalus is treated with surgery in Iran, There are no effective medicines for hydrocephalus. Most children require surgery. The goal is to lessen the pressure in the brain by providing another pathway for CSF to be drained and absorbed away from the brain.

There are two types of surgery for hydrocephalus:

  • The most common treatment is the insertion of a shunt. The shunt works by moving fluid from an area where there is too much CSF to an area where it can be absorbed into the body.
  • Some children with non-communicating hydrocephalus can have surgery called an endoscopic third ventriculostomy (ETV). This surgery creates an opening to allow CSF to flow in and around the brain as it should.

Both these surgeries are described in detail below.

 

  • Shunt surgery for hydrocephalus treatment in Iran

The most common treatment of hydrocephalus is the surgical placement of a shunt. A shunt is a soft, flexible tube.

The top end of the shunt is placed in the ventricle fluid spaces inside the brain. This tube is attached to a valve that controls the flow of CSF through the shunt. The tube is then tunnelled below the skin to an area of the body where the fluid can be absorbed. One area is the lining of the abdominal cavity (the peritoneum). This is called a ventriculo-peritoneal shunt (VP shunt).

Less often, the shunt is connected from the brain to other parts of the body:

  • A shunt from the brain to the lining around the lung (pleural space) inside the chest is called a ventriculo-pleural shunt.
  • A shunt from the brain to veins draining into the heart is called a ventriculo-atrial shunt.
  •  

During the shunt operation in hydrocephalus treatment 

Your child is brought down to the operating room and goes to sleep under general anesthesia. Your child will not feel any pain during the operation.

The area from the head to the abdomen (belly) is scrubbed with a special soap. The surgeon makes incisions (cuts) on the head and abdomen. The shunt tubing is tunnelled just below the skin. The ventricular (top) end of the shunt is passed through a small hole in the skull made by the surgeon and gently passed into the ventricle. The abdominal (bottom) end is passed through a small opening in the abdomen. The incisions are then closed using staples or stitches.

 

The operation takes between one and two hours.

  • Endoscopic third ventriculostomy (ETV) surgery for hydrocephalus treatment in Iran

An endoscopic third ventriculostomy (ETV) is the second type of surgery done on some children who have hydrocephalus. Your surgeon will tell you if this surgery is possible for your child.

During an ETV, the surgeon makes an opening in the floor of the ventricle at the base of the brain. The CSF is then no longer blocked inside the ventricle. Now it can flow in and around the brain as it should.

This means that the child will not need a shunt, but instead will rely on the opening made by the surgeon during surgery. It is still very important to watch your child for signs that the pressure is building up again, as it is possible that the ETV could fail or become blocked. If any signs come back, it is very important to call your surgeon right away so that your child can be checked.

 

During the ETV operation

Your child is brought down to the operating room and is put asleep under general anesthesia. Your child will not feel any pain during the operation. An incision is made on the head. A special scope with a camera on it is passed into the ventricle. The surgeon uses the camera to see the part of the ventricle that needs to be opened up. Once the opening is made, the surgeon will be able to see if the CSF is now flowing outside of the ventricle.

If the surgeon is not able to safely do the ETV, a shunt will be inserted instead. The incisions are then closed using staples or stitches.

The operation takes between one and two hours.

 

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Hydrocephalus recovery in Iran

After the shunt or ETV operation in Iran

Your child is then taken to the Post Anesthetic Care Unit (PACU) recovery room. Your child will wake up soon after the operation. You will be able to see your child as soon as he wakes up. Your child will spend about one to two hours in the PACU to recover from the anesthetic. Then your child will be returned to his room in the neurosurgical unit.

Your child will have a bandage on the head. If your child received a shunt, they will have another bandage on the abdomen or chest, depending on the type of shunt.

The nurse will check your child often. They will also be checking to see how easily your child wakes up, even at night.

Your child will have an intravenous (IV) line after surgery until they are drinking well.

Your child may have a CT scan after surgery to make sure the ventricles have decreased in size and, if your child needed a shunt, that the shunt is in a good position.

What are the complications of hydrocephalus treatment in Iran?

Both surgical procedures can result in complications. Shunt systems can stop draining cerebrospinal fluid or poorly regulate drainage because of mechanical malfunctions, blockage or infections. Complications of ventriculostomy include bleeding and infections.

Any failure requires prompt attention, surgical revisions or other interventions. Signs and symptoms of problems may include:

  • Fever
  • Irritability
  • Drowsiness
  • Nausea or vomiting
  • Headache
  • Vision problems
  • Redness, pain or tenderness of the skin along the path of the shunt tube
  • Abdominal pain when the shunt valve is in the abdomen
  • Recurrence of any of the initial hydrocephalus symptoms

 

10 common questions about hydrocephalus treatment in Iran

1Can hydrocephalus be treated with medication?
Acetazolamide (ACZ) and furosemide (FUR) treat posthemorrhagic hydrocephalus in neonates. ... Medication as treatment for hydrocephalus is controversial. It should be used only as a temporary measure for posthemorrhagic hydrocephalus in neonates, or when shunting is not possible
2Can hydrocephalus go away?
In an adult, the skull is rigid and cannot expand, so the pressure in the brain may increase profoundly. Hydrocephalus is a chronic condition. It can be controlled, but usually not cured. With appropriate early treatment, however, many people with hydrocephalus lead normal lives with few limitations
3What is the main cause of hydrocephalus?
Hydrocephalus from birth Some premature babies have bleeding in the brain, which can block the flow of CSF and cause hydrocephalus. Other possible causes of congenital hydrocephalus include: X-linked hydrocephalus – caused by a mutation of the X chromosome. rare genetic disorders – such as Dandy Walker malformation.
4What is the survival rate of hydrocephalus?
The mortality rate for hydrocephalus and associated therapy ranges from 0 to 3%. This rate is highly dependent on the duration of follow-up care. The shunt event-free survival is approximately 70% at 12 months and is nearly half that at 10 years, post-operatively.
5Can a child with hydrocephalus live a normal life?
Most of the newborns born with hydrocephalus will have a normal lifespan, and approximately 40 to 50 percent will have normal intelligence. Seizure disorders have been diagnosed in about 10 percent of children with hydrocephalus. The mortality rate for infants is approximately 5 percent.
6Can you live a normal life with a shunt?
Can I live a normal life with a shunt? Most of hydrocephalic patients will be required to keep their CSF shunt all life long. One of the advantages of this therapy is that it allows you to have a normal daily life. The shunt will restore the CSF circulation to regulate its flow
7Does hydrocephalus shorten life?
Children often have a full life span if hydrocephalus is caught early and treated. Infants who undergo surgical treatment to reduce the excess fluid in the brain and survive to age one will not have a shortened life expectancy due to hydrocephalus. Adults who develop hydrocephalus typically have a shortened life span
8How long can you live with a shunt?
Shunting is successful in reducing pressure in the brain in most people. VP shunts are likely to require replacement after several years, especially in small children. The average lifespan of an infant's shunt is two years. Adults and children over the age of 2 may not need a shunt replacement for eight or more years
9Does hydrocephalus affect memory?
Damage to the frontal lobes or connections with other brain areas and functions can make it difficult for executive functions to work the way they should. This can happen as a result of hydrocephalus (see About Hydrocephalus). Problems with working memory can happen when we try to process a lot of information quickly.
10Can drinking too much water cause hydrocephalus?
Drinking too much water may cause brain swelling: Experts. Drinking too much water can cause excess fluid accumulation, leading to dangerously low sodium levels in the blood or hyponatremia - a life-threatening condition that can result in brain swelling, scientists warn

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