Pediatric Hydrocephalus


The hydrocephalus is derived from Greek words hydro, which means water, and kephalê, which means head. It is a severe neurological abnormalities, defined by the increase in the volume of spaces containing the cerebrospinal fluid (CSF): brain ventricles and subarachnoid space. This expansion may be due to hypersecretion CSF, a lack of absorption, or a mechanical obstruction of traffic lanes.

The hydrocephalus was first described by Hippocrates, but could not be successfully treated until the twentieth century with the advent of neurosurgical techniques appropriate.

Hydrocephalus communiquante
It is also called hydrocephalus normotensive which is an expansion of the ventricular system in the presence of a pressure more or less normal level of cerebrospinal fluid. The dynamics of cerebrospinal fluid is disturbed. It may be secondary to hemorrhage, which is itself due to an arteriovenous malformation, a subarachnoid hemorrhage, trauma or a problem idiopathic.


* Signs of confusion (dementia);
* A ataxia the march;
* Incontinence (sphincter disorders);
* CT scan or MRI (ventricular dilation)

The evolution can be stopped by medical treatment or surgery ventricular bypass.

Hydrocephalus obstructive
It comes with an intra-cranial hypertension and represents a medical emergency a major risk of cerebral commitment, requiring the installation of a bypass ventricular emergency. Its causes are:

* Brain tumors (benign or malignant) compressing the third and / or fourth ventricle brain (hence blocking taxiways and accumulation in the ventricles LCR)
* Congenital hydrocephalus, a brain malformation,
* A tumor choroid plexus (extremely rare), responsible for a hypersecretion CSF,
* The partitioning meningeal (as part of a meningitis)
* Bleeding meningitis.
* This type of hydrocephalus is the prerogative of the infant and expressed by an increase in head circumference, a bulging fontanelles, eyes a sunset characteristics. This hydrocephalus malformation often accompanies defects closure (dysraphies) of neural tube (méningocèles, myélo-méningocèles).

Hydrocephalus at normal pressure
It is also known as syndrome Adams and Hakim.

It is a variety of hydrocephalus linked to a low obstruction taxiways CSF (downstream holes of the fourth ventricle, usually at the tank base), met at the old topic. It is not accompanied by intracranial hypertension, its symptoms are progressive and insidious onset.

* Problems with balance and walking (the earliest sign) to walk with small steps, antépulsion. At most, walking and standing are impossible. Importantly, the neurological examination shows no motor or sensory disorder.
* Troubles sphincteriens: incontinence (late).
* Dementia: too late, it is akin to a frontal syndrome.

These signs are not specific hydrocephalus: clinical diagnosis is difficult, is medical imaging, which provides the best certainty.

Further testing
* The brain scanner (without injection of iodine) is an expansion quadriventriculaire without enlargement of cortical paths (which helps differentiate hydrocephalus and cerebral atrophy)
* The lumbar puncture évacuatrice can often temporarily improve symptoms (especially disorders of the foot). His analysis reveals a normal LCR.

It is a treatment neurochirurgical consisting of the establishment of a bypass ventriculo-peritoneal (DVP), the derivation is internal between the ventricular system and the peritoneum (or heart, more rarely) that will drain excess CRL. The effects are inconsistent from one patient to another: the motor recovery is often very satisfactory if the treatment is early (disorders of walking without dementia if sphincter disorders), when good response to the lumbar puncture évacuatrice, and case of hydrocephalus secondary (to trauma, infection, etc.).. When the blockage lies beyond holes Monro and third ventricle, is conducting a ventriculo-cisternostomie (VCS) with endoscopy transventriculaire and effondrant the floor of V3 with an inflatable balloon. The risks of these interventions are the same as those associated with any surgery.

* Infectious: It can declare himself a few days or weeks after the operation. The severity of the infection can be very variable and dictates the treatment. Often local treatment of the wound enough, but sometimes we should réintervenir and / or treat the patient then by antibiotics.
* Hémorragique (blood clot): It occurs most often in the first 48 hours after the operation. A hematoma can be created anywhere on the path insertion of the probe or drain. Depending on its severity, this is guarded haematoma will require either a recovery operation. This can be manifested by a worsening neurological due to compression from a clot.
* If hyperdrainage of the bypass valve, it can also occur a subdural hematoma requiring its evacuation and temporary clamping of the valve.
* Obstruction, filling: This is not malfunction delayed predictable and can occur even after many years.

Read also Hydrocephalus