We understand Hydrocephalus

Hydrocephalus is also known as “water on the brain”. It is caused by an abnormal accumulation of cerebrospinal fluid (CSF) in the inner of the brain (ventricles of the brain). The ventricular system consist of four ventricles connected by narrow passages. CSF flows through the ventricles before it exits into a cavity, the so called subarachnoid space.

CSF covers the brain and the spinal cord and usually reabsorbs into the bloodstream, thus production and absorption is normally balanced. CFS has amongst others the following important life-sustaining functions:

• To act as a cushion or "shock absorber“ against injuries
• To deliver nutrients and proteins that are needed for the nourishment and normal function of the brain

An imbalance in production and absorption results in an abnormal widening of the ventricles. Due to the enlargement of the ventricles the pressure on the brain (intracranial pressure) rises which can lead to serious neurological damages of the brain.
In some cases the cause of hydrocephalus are not clearly identifiable.

Hydrocephalus can be classified as

Communicating

• CSF circulation via the ventricles of the brain is intact, but the absorption into the venous bloodflow is blocked

and Non-communicating or Obstructive

• Circulation of CSF is blocked somewhere between the lateral, third and/or fourth ventricles.

Other classifications are:

Congenital hydrocephalus is present at birth. Children born with hydrocephalus may be diagnosed during the pregnancy or at birth. Often children born with hydrocephalus do have an abnormal head circumference. Congenical hydrocephalus can occur together with diseases like:

• Spina Bifida 
• Dandy-Walker syndrome
• Aquaduct Stenosis

Acquired hydrocephalus can occur at any stage in human lifetime as a consequence of an accident, surgery, cerebral bleeding, tumor, meningitis and/or others.

A special form of acquired hydrocephalus is the so called Normal Pressure Hydrocephalus (NPH).

Normal pressure hydrocephalus describes a neurologic condition of ventricular dilatation in the absence of increased CSF pressure. NPH is characterized by a triad of gait impairment (a broad-based, shuffling, magnetic gait), urinary incontinence and a form of dementia.

The importance of this diagnosis lies in the fact that it is a potentially reversible cause of dementia.

The cause of NPH is often unclear. These cases are called “primary” or “idiopathic” NPH (iNPH). The remaining cases are so called secondary NPH (sNPH). The cause of the disease known and secondary to either a head injury, subarachnoid bleeding, meningitis or a tumor.

NPH is a disease of the elderly population, with an increasing incidence beginning between the ages of 65 and 70 years.

The symptoms of hydrocephalus vary with the age of the patient furthermore other diseases may influence those symptoms.

Depending on patients age and symptoms, there are different options to diagnose hydrocephalus. A diagnose normally always consist of imaging techniques like ultrasonography, computed tomography (CT) or magnetic resonance tomography (MRT). With the help of the imaging techniques shape and size of the ventricles become visible.

Endoscopic Procedure

In the event of a non-communicating hydrocephalus, an endoscopic procedure (endoscopic third ventriculostomy (ETV)) often is the treatment of choice. Through a small opening in the head, the surgeon is using an endoscope to either remove the blockage or to open the ventricles allowing the CSF to circulate again.