What is hydrocephalus in a child? Possible consequences and prevention. Emergency surgical care for closed hydrocephalus

Hydrocephalus in children is a brain disease that develops as a result of excessive accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain and/or subarachnoid space. Since the child’s brain continues to form after birth, the development of hydrocephalus can stop this process, leading to serious consequences in the form of retardation in physical and neuropsychic development. Sometimes the consequences of hydrocephalus suffered in childhood interfere with a full-fledged existence. Careful observation of the child by a pediatrician and related specialists (in particular a neurologist) makes it possible to timely detect the initial manifestations of hydrocephalus in children and eliminate it.

In order to start treatment on time and minimize complications and unpleasant consequences, it is important for parents to know the causes of this disease.

Functions of cerebrospinal fluid

Liquor is a special liquid that washes the brain from all sides. Inside the brain, it is contained in the ventricles - cavities inside the brain tissue, outside - between the soft and arachnoid membranes. In children, the amount of cerebrospinal fluid ranges from 40 ml to 100-150 ml, depending on age. During the day, the cerebrospinal fluid is renewed several times. This occurs due to the continuous production of cerebrospinal fluid by the choroid plexuses of the ventricles of the brain and its simultaneous absorption into the venous and lymphatic system through outgrowths in the membranes of the brain (arachnoid villi, Pachionian granulations) and perineural spaces.

Normally, the ventricles of the brain communicate with each other (foramen of Monro, cerebral aqueduct) and with the subarachnoid space (foramina of Magendie and Luschka). The continuous process of cerebrospinal fluid dynamics provides the brain with nutrients, forms its defense (antibodies, neutrophils), and protects it from injury.

If for some reason the exchange and flow of cerebrospinal fluid is disrupted, hydrocephalus develops.

Causes of hydrocephalus in children

Hydrocephalus syndrome in children has a fundamental division into congenital and acquired. Among the factors contributing to the occurrence of congenital hydrocephalus are:

• anomalies and malformations of the nervous system (Dandy-Walker syndrome, Arnold-Chiari anomaly, stenosis or atresia of the Sylvian aqueduct, hypoplasia of the subarachnoid space, underdevelopment or aneurysm of the great vein of the brain, etc.): they are formed during pregnancy in utero under the influence of various teratogenic influences. These may be infections suffered by the mother during the development of the brain in the first trimester of pregnancy (rubella, toxoplasmosis, herpes, cytomegalovirus infection are especially dangerous); bad habits – smoking, alcoholism, drug use;
• intracranial birth trauma, such as subarachnoid and intraventricular hemorrhages, asphyxia during childbirth. The risk of developing hydrocephalus increases in premature infants with low birth weight.

Acquired hydrocephalus can develop with:

• inflammatory diseases of the brain and its membranes (encephalitis);
• tumors of the brain and skull bones;
• brain injuries received after birth;
• rupture of arteriovenous malformations of the brain.

Classification

Depending on where excess cerebrospinal fluid predominantly accumulates, external (in the subarachnoid space), internal (in the ventricles of the brain) and mixed (general) hydrocephalus are distinguished.
According to the development mechanism:

• open (communicating) – if the communication between the ventricles of the brain and the subarachnoid space is preserved;
• closed (non-communicating, occlusive) - when the circulation of cerebrospinal fluid between the ventricles of the brain and the subarachnoid space is impossible due to blockage or atresia of the foramina of Magendie and Luschka. This is the most dangerous and prognostically unfavorable type of hydrocephalus, requiring immediate neurosurgical intervention;
• hypersecretory (hyperproduction) – with increased secretion of cerebrospinal fluid by the choroid plexuses.

According to the level of intracranial pressure:

• hypertensive - high blood pressure. The most common form in children;
• normotensive - with normal blood pressure. Usually observed in the very initial stages, then gives way to hypertension;
• hypotensive – with low blood pressure. Very rare.

Symptoms

Clinical manifestations in children of the first years of life before the closure of cranial sutures and overgrowth of the fontanel differ from all other age groups.

With an increase in the amount of cerebrospinal fluid and an increase in intracranial pressure in children in the first two years of life, an increase in the size of the head occurs due to the fact that the bones of the skull are loosely fused to each other. The head looks disproportionately large compared to the body. In pediatrics, the norms for the increase in head circumference per month in the first months and years of life are clearly defined. Measuring this indicator monthly allows us to judge the possible onset of hydrocephalus. In addition, with an increase in intracranial pressure, the bulging and pulsation of the large fontanel attracts attention.

There may be divergence of cranial sutures, increased patterning, and overflow of extracranial veins with blood, which can be seen when viewed with the naked eye. The brain part of the skull predominates over the facial part. Characteristic ocular manifestations are: divergent strabismus, the “setting sun” or Graefe symptom (with an involuntary downward movement of the eyes between the edge of the eyelid and the iris, a white strip of sclera remains, the eyes seem to roll back), exophthalmos (protruding eyeballs).

The behavior of children suffers: they are whiny, they are characterized by monotonous crying “on one note”, they are restless, they sleep poorly. When feeding such children, excessive regurgitation is possible.

With hydrocephalus, children are delayed in motor development: later they begin to hold their head up, roll over, and sit. With severe hydrocephalus, the formation of these skills does not occur at all, paresis and paralysis develop (decreased muscle strength in the limbs) with an increase in muscle tone. Convulsive syndrome may occur. There is also a lag in neuropsychic development: late smiling, lack of a revival complex in the first months, the child does not follow the toy, humming and subsequent speech are not formed. Intellectual development suffers.

Children who have already had fusion of the fontanelles and the cranial sutures are tightly fused have slightly different symptoms. Their head shape is normal, the proportions between the brain and facial skeletons are preserved. Such children complain of intense headaches, more often in the first half of the day, frequent nausea and vomiting, which occur in the absence of errors in nutrition. Spontaneous nosebleeds are possible.

Vision suffers: sharpness decreases, double vision appears, signs of congestive optic discs are visible in the fundus. Possible convulsive syndrome with loss of consciousness, unsteadiness when walking and loss of coordination. Such children also lag behind their peers in physical and neuropsychic development. With the long-term existence of hydrocephalus, a decrease in muscle strength and urinary function disorders in the form of urinary incontinence develop.

Diagnostics

Ultrasound examination is a modern and fairly informative method for detecting hydrocephalus in children. Ultrasound is performed in the antenatal clinic to clarify the development of the brain in the fetus. Until the fontanel closes, the presence of hydrocephalus can be determined using neurosonography - ultrasound through the fontanel.

The dynamics of head growth in cm in the first year of life, despite its simplicity, has not lost its diagnostic significance to this day.

A non-invasive method for diagnosing hydrocephalus in children is cranial transillumination: examination of the head using a tube with a lamp. The presence or absence of hydrocephalus is judged by the degree and size of the glow.

CT and MRI are used to diagnose hydrocephalus following an ultrasound scan of the brain.
Additional methods to confirm the diagnosis include fundus examination and EEG in the presence of convulsive syndrome.

Treatment

Treatment of hydrocephalus in children can be conservative and surgical. Conservative treatment is effective in cases with open, non-progressive hydrocephalus.

In order to reduce the production of cerebrospinal fluid and improve cerebrospinal fluid dynamics in children, it is allowed to use diacarb (acetazolamide), furosemide (Lasix), mannitol, glycerin (convenient because it is taken orally).
If there is no effect from taking medications, as well as in cases where the disease progresses, in the presence of closed hydrocephalus, surgical treatment is indicated.

External ventricular drainage is performed in urgent cases when increasing symptoms of increased intracranial pressure threaten the child’s life.

If the cause of the disturbance in the flow of cerebrospinal fluid is a tumor or hematoma, then its removal is indicated, which in itself allows restoring normal cerebrospinal fluid dynamics.

CSF shunting operations (ventriculoperitoneal, ventriculoatrial, lumboperitoneal shunting) are routinely performed. With the help of systems of tubes and valves, it is possible to drain excess cerebrospinal fluid from the brain into the body cavity (abdominal, pelvic, atrium). Of course, these are very traumatic operations, but if they are performed successfully, the child gets the opportunity to live a full life and does not suffer from physical and intellectual development.

Consequences

The prognosis of hydrocephalus in children depends on many factors. The cause and mechanism of development, the level of intracranial pressure, age of development and duration of existence play a role.

With communicating forms of hydrocephalus, the prognosis is more favorable than with occlusive forms.

In general, with early diagnosis and successful treatment, recovery is possible without delays in the physical and neuropsychic development of most children.

Video on the topic “Hydrocephalic syndrome”

Hydrocephalus, or dropsy of the brain is a disease in which excessive amounts of cerebrospinal fluid accumulate in the ventricles (internal cavities) of the brain and under the meninges.

Some facts about hydrocephalus:

• According to statistics, this disease occurs in 1 out of 500-1000 newborns.
• Hydrocephalus is the most common developmental disorder in children, which is more common than Down syndrome and congenital deafness.
• There are only about 700,000 children and adults living in the United States today with hydrocephalus.
• In Western countries, hydrocephalus is the most common cause of brain surgery in children.
• There are more than 180 different causes of this disease. The most common is perinatal damage (shortly before, during or immediately after childbirth).
• 25 years ago, more than half of patients with hydrocephalus died. Today the mortality rate has dropped to 5%.

Features of the anatomy of the central nervous system. What is cerebrospinal fluid? How is it formed and removed?

Functions of cerebrospinal fluid:

• Acts as a shock absorber and protects the brain from damage during impacts.
• Removes waste, metabolic products that are formed in the brain.
• Delivers some essential substances to the brain.

The formation of cerebrospinal fluid occurs mainly due to the many small vessels located in the walls of the cerebral ventricles. Every minute an adult produces approximately 0.35 ml of cerebrospinal fluid, and about 500 ml per day. The same amount should be absorbed into the veins of the brain. This is how it is constantly updated.

Normally, cerebrospinal fluid pressure fluctuates within certain limits. For an adult, this interval is 70-180 mm. rt. Art., for children the numbers are lower, according to age.

Hydrocephalus develops when there is a discrepancy between the amount of cerebrospinal fluid produced and absorbed. This can happen for various reasons.

What types of hydrocephalus are there?

• Closed (syn.: non-communicating, occlusive). A blockade occurs, as a result of which the outflow of cerebrospinal fluid to the place where it is absorbed is disrupted. This condition can be compared to a pinched garden hose. Above the block, the pressure of the cerebrospinal fluid increases.


• Open (communicating). In this form of hydrocephalus, cerebrospinal fluid circulates freely, but it is not absorbed or is absorbed less intensely than it should.

Types of hydrocephalus, depending on the time of occurrence:

• congenital
• acquired

• Acute. Dropsy of the brain and elevation increase very quickly. This is more typical for closed hydrocephalus. The child's condition is deteriorating sharply and urgent medical attention is required.
• Chronic. The increase in intracranial pressure increases gradually. This is more common with communicating hydrocephalus.

Types of hydrocephalus depending on the location of the dropsy:

Types of hydrocephalus depending on the severity of the disorders to which it leads:

• Compensated– there is hydrocephalus, but it does not manifest itself with practically any symptoms, the child’s condition is practically not disturbed, he develops normally.
• Decompensated– dropsy of the brain leads to pronounced disorders.

The main causes of hydrocele in children:

Cause	Description
Fetal infections Congenital malformations of the brain
Chiari syndrome (Arnold-Chiari syndrome, Arnold-Chiari malformation)	A condition in which the brain is larger than the space inside the skull. Due to this, the cerebellum shifts downward, the lower parts of the brain are compressed, and the outflow of cerebrospinal fluid is disrupted. Previously it was believed that this was a congenital disease. Scientists are now inclined to believe that the disorders occur as a result of rapid brain growth.
Congenital narrowing of the cerebral aqueduct	Waterhole The cerebral duct is a channel that connects the cerebral ventricles. This is where cerebrospinal fluid normally drains. Narrowing of the cerebral aqueduct is a congenital disorder, but it usually begins to manifest itself with age.
Underdevelopment of the openings that are necessary for the normal outflow of cerebrospinal fluid	These disorders also lead to the development of closed hydrocephalus.
Rare malformations associated with chromosomal abnormalities
Other causes of hydrocephalus in children
Intracranial tumor	A tumor of sufficiently large size compresses the brain, leading to displacement of brain structures. Closed hydrocephalus develops.
Hemorrhage	Depending on its location and size, an intracranial hematoma (a collection of blood) can also compress brain structures and impair the outflow of cerebrospinal fluid.
Infections	Meningitis and meningoencephalitis - inflammation of the brain and meninges - lead to impaired absorption of cerebrospinal fluid. Open hydrocephalus develops.

What happens with hydrocephalus?

After birth, the skull consists of several individual bones - they continue to grow. At a certain age, they must grow together and bone sutures are formed. In children with hydrocephalus, these processes are disrupted. Their skull bones diverge to the sides, grow together more slowly, and become thinner.

Signs of hydrocele in a child

Signs of hydrocephalus in older children (mostly all of them are associated with increased intracranial pressure):

• headache;
• lethargy, drowsiness;
• increased irritability;
• poor appetite;
• nausea, vomiting;
• visual impairment, double vision;
• convulsions and breathing problems (usually during an attack with open hydrocephalus).

What could be the consequences of hydrocephalus for a child in the future?

• decreased attention;
• difficulties with learning at school, the child does not learn new information well;
• movement coordination disorders;
• memory problems;
• speech defects;
• visual impairment, up to complete blindness.

Diagnosis of hydrocephalus

Diagnosis of hydrocele in the fetus before birth

Diagnosis of hydrocele of the brain after the birth of a child

Diagnosis of hydrocephalus:

Treatment of hydrocephalus in children

Conservative therapy is used for compensated forms of the disease, when a small excess amount of fluid accumulates in the cranial cavity, intracranial pressure is slightly increased, and there are no or mild symptoms. Such children are under the supervision of a neurologist.

Which doctor treats hydrocephalus?

• neurosurgeon;
• pediatric surgeon;
• neurologist;
• ophthalmologist: with hydrocephalus, compression and dysfunction of the optic nerve often occurs, decreased vision, even complete blindness.

Drug treatment of hydrocephalus

Emergency surgical care for closed hydrocephalus

In this case, compression of the nerve center responsible for regulating breathing often occurs. This threatens respiratory arrest and death.

In such cases, it is necessary to quickly remove excess cerebrospinal fluid and reduce intracranial pressure.

Carrying out emergency surgery:

• The child is given anesthesia.
• A hole is made in the skull. If the seams and fontanelles are not yet overgrown, then a puncture can be made. For older children, cutters are used.
• A silicone catheter is inserted into the brain ventricle and immersed to the required depth. With some malformations, it is necessary to drill two holes and install two catheters in both ventricles - the right and left.
• The other end of the catheter is connected to a special container.

Surgical treatment of open and closed hydrocephalus in children

Before surgery, cerebrospinal fluid pressure can be reduced using a spinal tap: the doctor places the child on his side, inserts a needle between the lumbar vertebrae, and removes some cerebrospinal fluid.

Diseases for which spinal taps are indicated before surgery:

• meningitis and meningoencephalitis;
• intracranial hemorrhages.

Indications	Type of operation
Closed hydrocephalus	Removing an obstruction that is blocking the flow of cerebrospinal fluid: tumor; hematoma; cyst; vascular aneurysm. After the obstruction is removed, the cerebrospinal fluid begins to flow freely to the place where it should be absorbed.
Closed hydrocephalus, in which the obstruction cannot be removed	For example, some tumors grow into the brain, do not have a clear border, and it is impossible to remove them without damaging healthy nerve tissue. In such cases, the surgeon creates a workaround - he makes an artificial hole through which the cerebrospinal fluid begins to flow. Sometimes a catheter is installed - a tube that drains cerebrospinal fluid, bypassing the site of narrowing. Previously, patients endured such operations very difficult. But today new endoscopic techniques have appeared.
Open hydrocephalus	With open hydrocele, cerebrospinal fluid is not absorbed where it should normally occur. The surgeon’s task is to take it to another place, to a place where it can be absorbed. Previously, this was impossible to do - open hydrocephalus was considered a serious incurable disease. But in the middle of the last century, special silicone catheters appeared. Thanks to them, surgeons today successfully cope with the disease. Types of operations, depending on the location of the cerebrospinal fluid drainage: How the operation is performed? The child is given anesthesia. The surgeon makes two incisions: one on the head and one on the abdomen. One end of the catheter is immersed in the abdominal cavity. A tunnel is made under the skin up to the head, through which a catheter is passed. The second end of the catheter is immersed in the cerebral ventricle. Check the patency of the catheter. All wounds are sutured. As the child grows, the catheter must be replaced with a longer one. Modern catheters are equipped with special valves. They help regulate the level of cerebrospinal fluid pressure and prevent it from rising and falling excessively. The type of valve is selected by the attending physician. Possible complications after catheter installation: Impaired patency. Causes: incorrect installation (kinks, punctures); blockage by adhesions inside the skull, tumor cells, inflammatory cells, hematoma; blockage by adhesions inside the abdominal cavity. Infection. Causes: violation of the rules of asepsis and antisepsis during surgery; any inflammatory processes: infection can enter the catheter site through the bloodstream. Sharp fluctuations in intracranial pressure. It may be excessively increased or decreased. It is difficult to select a catheter that would provide optimal performance the first time. In these conditions, the catheter must be replaced.

Prevention of hydrocephalus

• prematurity;
• various pathologies during pregnancy in the mother, in particular infections;
• malformations of the nervous system: spina bifida, cerebral hernia, etc. (hydrocephalus can develop much later, after the child has been operated on for the defect and has had time to grow up);
• tumors of the brain and spinal cord;
• previous meningitis, meningoencephalitis, infections of the nervous system;
• intracranial hemorrhages;
• suffered head injuries.

Hydrocephalus often develops after traumatic brain injury, so an important preventative measure is to protect children from injury:

• use of child seats in cars;
• walks – on specially equipped, safe playgrounds;
• protection of a small child in the house: you need to purchase special covers for all sharp corners, remove all heavy, unstable objects;
• When riding a bicycle, skateboard, rollerblades, etc., the child must wear a helmet and other protective equipment.

Hydrocephalus is the accumulation of fluid from the spinal cord into the brain, including into its ventricles. This factor is accompanied by intracranial pressure. This disease can be caused by an infection or another reason. The picture of this manifestation is as follows: a large amount of fluid leaves the spinal cord, which is subsequently retained in the brain. There are 2 classes of this disease:

• primary, resulting from congenital anomalies;
• secondary, acquired in the womb during infection of the fetus.

The disease is classified in the following areas:

• acquired pathology;
• congenital disease;
• open or communicating hydrocephalus;
• closed, or occlusive, hydrocephalus;
• resulting from atrophy of brain cells;
• normotensive, or normal blood pressure.

Hydrocephalus of the brain in the fetus occurs due to many factors, but still mainly these are infections that enter the mother’s body. And the earlier this happens, the worse it is for the unborn baby.

List of probable causes accompanying the development of hydrocephalus:

1. Sexually transmitted infectious diseases. Syphilis leads to dysfunction of the nervous system and also contributes to the development of dropsy.
2. Ureaplasmosis. Whether the disease can occur as a result of this infection is still a controversial issue, but there have been cases recorded on fetal ultrasound during pregnancy.
3. The presence of chlamydia infection in the womb also causes this pathology and, along with it, affects visual functions and the nervous system.
4. Toxoplasmosis - these harmful pathogens arise from contact with animals, as well as from eating poorly processed meat. It is especially dangerous when it is early in pregnancy.
5. The causative agent of rubella infection, upon penetration, can cause miscarriage in early pregnancy. But if the fetus becomes infected in the later stages, it is possible that this will cause hydrocele in the fetal brain.
6. If the mother has herpes during pregnancy, then the risk of hydrocephalus exists in half of the cases. Children also experience damage to the skin and nervous system.
7. Cytomegalovirus - this infection affects the cellular level of the nervous system and contributes to the development of abnormalities, including hydrocephalus.
8. Chiari syndrome, or a congenital pathology in which the cerebellar trunk descends into the occipital region. This is where the circulation of spinal cord fluid is disrupted. The brain increases in size, but the skull remains small.
9. With chromosomal abnormalities or Edwards syndrome, almost all organs are affected, so such newborns die in the first months of life.
10. When the cerebral aqueduct is narrowed, which is one of the congenital factors of the disease, the outflow of fluid from the brain is impaired. More often this manifests itself at a certain age.
11. Bad habits that a woman indulged in during pregnancy also contribute to the development of hydrocephalus. For example, drinking alcohol and smoking, taking medications not prescribed by a specialist, exposure to harmful factors during fetal formation.

Symptoms of hydrocephalus

As mentioned earlier, dropsy during fetal development occurs when the outflow of fluid from the brain is disrupted, which ensures its accumulation. This factor increases intracranial pressure and leads to frequent migraines.

Some symptoms of hydrocephalus:

• constant feeling of nausea;
• vomit;
• headaches of a prolonged nature and intensity;
• bad feeling;
• lethargy and drowsiness;
• increased blood pressure.

At the same time, vomiting and nausea can be easily confused with signs of toxicosis or with changes in hormonal levels during pregnancy. With late toxicosis, frequent headaches caused by increased intracranial pressure are also possible.

In these cases, inpatient treatment under the supervision of a specialist is necessary. And in order to timely monitor your health during pregnancy, you need to contact an antenatal clinic for the slightest reason.

Diagnosis of pathology

To detect the disease in the early stages, the most effective method is ultrasound. The head of the unborn child is measured by scanning, and the main parameter is the width of the ventricles located on the side; their size should not exceed 10 mm. An ultrasound is performed at 17 weeks and repeated at 22 weeks, but the average period is 26 weeks of pregnancy. Hydrocephalus on fetal ultrasound indicates the presence of a concomitant infection, which must be combated immediately.

Sonography is another method for determining fetal hydrocephalus, but it is performed only in large specialized medical centers.

To diagnose the disease in a pregnant woman, specialists use:

• fundus examination;
• Ultrasound of the brain;
• fetal computed tomography;
• examination using a magnetic resonance imaging scanner;
• consultations in genetic areas;
• neurosonography.

Examinations are prescribed based on the collected tests.

Consequences of pathology

All those factors that threaten the occurrence of negative consequences depend on developmental defects and the causes of the disorder. For example, if the size of the lateral ventricles has not reached 15 mm, and no other pathologies have been identified, then this can be easily treated during pregnancy. Then the baby will be born healthy.

If the size of the ventricles exceeds 15 mm, then fetal hydrocephalus begins to develop intensively, which will adversely affect the unborn child. The consequence in the presence of dropsy can be death, and diseases of the central nervous system are also possible.

Only preparation for future pregnancy and childbirth will not give pathology the opportunity to arise.

Treatment

If there are signs of the disease, you should consult a doctor. In turn, the specialist will prescribe a series of examinations and decide on treatment. If the pathology is caused by infectious diseases, then, as a rule, therapy is prescribed aimed at removing excess fluid from the body and reducing the production of cerebrospinal fluid. Vitamins and drugs to improve cerebral circulation may also be prescribed. Pregnant women diagnosed with hydrocephalus should not stay in rooms with elevated temperatures or drink a lot of fluids. In the early stages of the disease, therapeutic treatment is used, that is, the attending physician prescribes medications that are gentle for the woman and her unborn baby.

Modern medicine has two more unique treatment methods:

1. Using a puncture, excess fluid is pumped out inside the womb. This procedure is performed only once.
2. A special shunt is inserted into the fetal brain to drain cerebrospinal fluid or cerebrospinal fluid from the unborn child's brain. This condition persists throughout pregnancy.

If measures to protect the health of the unborn baby are not carried out in a timely manner, the consequences can be different and irreversible.

Preventive measures

If hydrocephalus does not have hereditary signs, then a woman must carefully monitor her health while expecting a baby. It is important to visit the clinic, get tested in a timely manner, eat right, spend more time in the fresh air, and take folic acid supplements for normal fetal development.

If there are infectious diseases, it is best to carry out treatment before planning a pregnancy, since many drugs are contraindicated during pregnancy. The bypass procedure for a woman should also be carried out before conceiving a baby. Preventive measures also include routine ultrasound examinations.

The brain is bathed in cerebrospinal fluid (CSF), which protects it from damage. Hydrocephalus of the brain in children develops with excessive production and accumulation of cerebrospinal fluid. Parents are concerned that doctors are talking about an increase in the frequency of detection of this pathology (7 out of 10 newborns). The indicators cited by experts only indicate the success of modern perinatal diagnostics and pediatrics. The statistics of true hydrocephalus, which requires serious medical care, are much more modest - 1–2 cases per 1000 newborns.

Cerebrospinal fluid should constantly circulate, but for various reasons it begins to stagnate under the membranes or in the ventricles of the brain. The process leads to the appearance of symptoms of hydrocephalus in children, deteriorating the quality of life not only for the child, but also for the entire family. Is there a cure for this disease? The achievements of neurosurgery and pediatrics are impressive, but the success of therapy is largely determined by the form of hydrocephalus, the quality of diagnosis and treatment. A favorable combination of these factors makes it possible to improve the quality and increase the life expectancy of sick children.

The total amount of cerebrospinal fluid in a newborn reaches a volume of 15–20 ml, in children under one year of age - 25–35 ml, in an adult - up to 150 ml. With dropsy, the volume of cerebrospinal fluid increases, in some cases up to 1000 ml. If more fluid is produced or its reabsorption decreases, hydrocephalus develops. When the path to the cerebrospinal fluid is blocked by a tumor or other obstruction, the brain tissue begins to absorb fluid, increasing intracranial pressure.

Forms and main causes of hydrocephalus in children

Signs of hydrops in the fetus are diagnosed as early as the 16th week of pregnancy.

Congenital hydrocephalus is characterized by a violation of the outflow of intracranial fluid caused by a hereditary disease transmitted through the X chromosome. The pressure of the fluid from the inside with external hydrocephalus in children under one year of age seems to push from the inside the bones of the skull that have not yet fused. The consequences of this process are very serious: the infant’s vision deteriorates, blindness develops, and convulsions occur.

Hydrocephalus in children is often caused by brain infections (encephalitis, meningitis). The inflammatory process, as well as the consequences of traumatic brain injuries, including birth injuries, and hematomas become obstacles to the circulation of cerebrospinal fluid. The slow constriction of fluid flow causes atrophic changes in the brain. With the acute development of this process, a coma occurs and children die.

Symptoms and course of the disease

The main signs of hydrocephalus in children under one year of age and older appear when there are serious disturbances in the production and circulation of cerebrospinal fluid. Excess cerebrospinal fluid accumulates in the ventricles of the brain. In some forms of the disease, cerebrospinal fluid fills the intrathecal spaces. The diameter of babies' heads increases disproportionately, which prompts parents to consult a neurologist for advice.

What features should parents of young patients pay attention to:

There is a so-called compensated form of hydrocephalus in children, when the disease does not progress and normal cerebrospinal fluid pressure is maintained. Parents should be aware that increased intracranial pressure, or hypertension, is not necessarily present in all types of hydrocephalus. Infants with soft skull sutures are characterized by expansion of the cranium. Due to this process, disruption of fluid production and circulation is compensated.

Excess cerebrospinal fluid and increased intracranial pressure are observed with hypertensive-hydrocephalic syndrome.

Hypertension causes headaches, epileptic seizures, blurred vision, and blindness in children. Doctors prescribe drug treatment, but it may be unsuccessful, then atrophy of brain tissue progresses. The chronic process lasts over 6 months. The development of the subacute form occurs over the course of a month, the acute form - several days.

Diagnostics

Congenital uterine infections during pregnancy increase the risk of children developing hydrocephalus. Among the reasons, experts also name pathologies of the central nervous system, head injuries, tumors, hematomas, which contribute to the development of dropsy. A neonatologist determines congenital hydrocephalus in a newborn in the first days of his life. If this does not happen, but the pathology is present, then during an examination of the baby it will be identified by an experienced pediatrician. The pediatrician takes head circumference measurements and determines age appropriateness. If abnormalities are detected, the pediatrician refers you to pediatric neurology for consultation.

Moderate internal hydrocephalus of the brain may occasionally appear in a child; most often, changes occur in severe conditions (high temperature, fever). In these cases, timely assistance provided to children eliminates possible complications.

Diagnostic methods:

1. Neurosonographic - in newborns and infants, hydrocephalus is determined through the fontanel.
2. Lumbar puncture - assessing the pressure of the cerebrospinal fluid, identifying infection.
3. Magnetic resonance and computed tomography (MRI and CT) - determining the form of the disease based on the picture of the cerebrospinal fluid tract.
4. Craniography - measurements of the skull, identification of suture dehiscence.
5. Magnetic resonance angiography and electroencephalography (EEG) are auxiliary methods.

Hydrocephalus is manifested by characteristic changes in the appearance and behavior of children. Parents should be concerned and contact a specialist if the volume of the head grows too quickly, a bulging fontanelle, or convulsions in infants. After examination and examination, doctors decide on treatment.

Medicines for the treatment of hydrocephalus

Experts prescribe medications to children based on a study of symptoms and diagnostic results. Conservative therapy will also be required for complications, which include epileptic seizures and mental retardation. For grade 1 hydrocephalus in a child, medications that normalize metabolism, diuretics, vitamin B6, and the drug “Asparkam” are prescribed. To combat excess fluid, Diacarb tablets are used.
Children are prescribed nootropic drugs Cavinton and Pantogam. In some cases, the doctor selects medications that reduce the production of cerebrospinal fluid. When a child has hydrocephalus, he can go to a child care center with mild forms. Many children with this diagnosis grow up and become healthy people.

Surgery

Late detection and complex forms of hydrocephalus in children require neurosurgical intervention. Timely treatment affects the quality and life expectancy of young patients. You can find out how long children with hydrocephalus live from neurosurgeons. According to statistics, people with this diagnosis die before the age of 10–12 years. The operation eliminates the risk to life in complex forms of the disease.

Shunting for hydrocephalus in children helps remove excess cerebrospinal fluid. A catheter or shunt is placed into the ventricle of the brain during surgery. The system is placed under the skin, its end is immersed in the abdominal cavity. It is periodically necessary to change the implanted shunts or tubes, for which operations are performed again once every two or three years.

Hydrocephalus of the brain develops in children under one year of age, and sometimes occurs at older ages. Dropsy is diagnosed somewhat less frequently in adult patients. Any of the options is life-threatening and requires adequate medical care as quickly as possible. If a doctor helps a child by quickly and accurately making a diagnosis and selecting appropriate therapeutic measures, the consequences will be minimal, and the person will live a long life. But if the disease cannot be detected really quickly, the results can be very disastrous - even death. However, as statistics show, the mortality rate is estimated at five percent, which means that the danger is not as great as it was, for example, several decades ago, when half of all patients died from dropsy.

general information

To understand the causes of hydrocephalus in children and the consequences of this disease, you first need to delve into the very essence of the disease. The name came to us from a foreign language and is translated quite simply - “water in the head.” This term well describes the patient’s condition - in the tissues of the brain there is an accumulation of a specific substance, a fluid circulating through the spinal cord and brain. This secretion is produced in excess and is not absorbed by the cells, so it accumulates in those channels through which the substance must move, ensuring the functioning of brain cells. There are channels both inside the skull and at the exit from this part of the body.

Hydrocephalus in children is a disease in which the size of the skull gradually increases under the influence of a negative factor. This is because the liquid cannot be compressed. When accumulated, it puts pressure on the surrounding tissues, bursting them. This process is especially noticeable if dropsy begins in a newborn or children in the first years of life, while the cranial bones have not yet fully formed and have plasticity, softness, and pliability. If the disease begins when the connections of the skull have become dense, there is no fontanel, then the pressure leads to the washing out of the cells by fluid. The skull no longer has pliable areas, so no enlargement of the head is observed.

Attention to all factors

To minimize the consequences of hydrocephalus in a child, at the first suspicion of the disease, you should show the baby to a qualified doctor for an accurate diagnosis. The choice of the correct therapeutic approach is possible only if it is possible to establish the cause that provoked the disturbance in the circulation of cerebrospinal fluid. The doctor evaluates the pressure and determines where the substance accumulates. It must be remembered that in some cases the onset of the disease is hidden. In order to notice that something is wrong in time, it is necessary to regularly undergo scheduled medical examinations with him from the very birth of the baby. If dropsy is detected in the primary stages, the disease can be successfully cured completely. Sometimes specific medications are enough. In more advanced cases, the only option is urgent surgery. They choose what to do in a particular case based on the examination. The decision is made by a council of doctors with the participation of a neurosurgeon and neurologist. If a compensatory condition is established, the slightest delay in surgical intervention can already cause death. Adequacy and timeliness of medical care are the main points that make it possible to save a life and restore health to a baby.

Unfortunately, it is not always possible to notice the first signs of hydrocephalus in children in time, since the disease can be hidden at first. This is explained by its features. Hydrocephalus is caused by an imbalance in the production and absorption of cerebrospinal fluid by the cells of the body. The human brain is a complex structured object, supplied with nutritional components through blood vessels. Brain tissue is elastic and dense, but the organ has cavities - the cerebral ventricles. The inner surface of these elements is covered with a vascular network that forms cerebrospinal fluid. The substance washes the spinal cord, penetrates between the meninges, where it is absorbed in the subarachnoid space. There are also vessels capable of absorbing fluid in the spinal column. The cerebrospinal fluid flows through the cranial venous sinuses designated for this purpose. Liquid is absorbed here only at the correct pressure levels, when there is a difference in this indicator in different tissues. If intracranial pressure is higher than sinus pressure, cerebrospinal fluid enters here. When the balance of fluid absorption and production is disturbed, dropsy develops.

Anatomical features

Hydrocephalus in children is associated with abnormal dynamics of the cerebrospinal fluid. Normally, this liquid is intended to protect brain tissue from injury and damage. This is achieved by its inability to shrink. At the same time, the substance washes the tissues, ridding them of metabolites and removing some other compounds. Due to the cerebrospinal fluid, which is always present in the same volume, a stable pressure is maintained inside the skull. The circulatory system receives certain benefits due to it - the water-electrolyte composition is stabilized. The autonomic nervous system is normalized due to the oscillatory movements of the fluid. To avoid any disruptions, the human body constantly produces cerebrospinal fluid, and is also constantly absorbed. The tissues produce 40-150 ml per day, specific parameters depend on the age of the child. In adults, this figure sometimes reaches one and a half liters in 24 hours. Liquor is rich in lymphocytes, protein structures, and electrolytes. The saturation with sugars and gases depends on blood parameters. Studies have shown that there is half as much sugar in the cerebrospinal fluid as in the main fluid of our body.

Hydrocephalus in children occurs when the balance between the production and absorption of cerebrospinal fluid is lost, and problems arise in passing through the vessels intended for this purpose. The level of disturbance and pressure indicators characteristic of the patient’s condition determine what happens in the cranial cavity. Certain parameters allow doctors to talk about whether a case belongs to one of the key forms. Correctly assigning a patient to a specific group is the key to a successfully selected treatment program.

What will the doctor say?

With hydrocephalus in children, there is an imbalance in the processes affecting the cerebrospinal fluid, and circulation suffers. To improve the situation, you should squeeze the liquid through the vessels responsible for its disposal. To do this, you have to increase the pressure inside the skull. Without adequate therapeutic assistance, natural processes lead to an expansion of the spaces occupied by cerebrospinal fluid in the skull. In the first few months after birth, the skull of infants is still plastic, so its volume changes quite easily under the influence of harmful factors, because the sutures and fontanelle have not yet fused. If the cerebrospinal fluid circulates incorrectly, the spaces allocated for it pathologically increase, and accordingly, the size of the brain tissue decreases. At first, the process is not so dangerous, because the fabrics are elastic, so slight compression occurs. But a gradual increase in the volume of cerebrospinal fluid leads to atrophic processes. It is atrophy that leads to outwardly visible symptoms of the disease.

The article contains photos of hydrocephalus in children. Most often, the disease develops during pregnancy, that is, it is a congenital disorder. This is explained by infection of the mother's body during the period of gestation of the embryo. In some cases, the cause is inflammatory processes affecting the central nervous system, injuries received at the time of birth or shortly after. Up to three quarters of all cases are caused by tumor processes in the brain.

Age and illness

Hydrocephalus of the brain in a child can occur in different ways, much depends on the age of the patient. This also applies to reasons. Some cause dropsy in young children, while others are dangerous for older people. At the stage of intrauterine development, quite often the disease is caused by malformations of the NS. Every fifth case is due to infection. A significant risk is associated with genetic disorders. But in a newborn, the disease in 80% of cases is caused by infection acquired while in the mother’s body. One in five people experience hydrocephalus due to injuries sustained at birth and shortly thereafter. spinal), inflammatory processes, meningitis, hemorrhage in the tissue inside the skull, tumors affecting the vessels through which blood is supplied to the brain - all these reasons can provoke dropsy in an infant.

At the age of one year and older, the following causes of brain hydrocephalus in a child are often found: hemorrhages, neoplasms in the brain and spinal cord. The disease can occur due to inflammatory processes in the brain and organ membranes. Dropsy is observed against the background of injuries, defects in the formation of blood vessels, and the brain. The cause may be heredity or genetic disorders.

Causes: diseases causing diseases

Cytomegalovirus and rubella can initiate hydrocephalus of the brain in children. Sometimes the disease develops against the background of infection with the first or second type of herpes. Toxoplasmosis and neurosyphilis are dangerous. Dropsy of the brain can develop against the background of mumps, viral or bacterial infection, which causes meningitis, meningoencephalitis. Infections with meningitis, pneumococci, and Haemophilus influenzae are dangerous. Hydrocephalus can be caused by various viruses from the herpetic family.

Sometimes hydrocephalus of the brain in children develops against the background of defects and specific conditions. The danger is associated with Arnold-Chiari syndrome. These are developmental features when the cranial occipital fossae do not correspond to the brain structures located in these areas. This leads to descent into the openings of the occiput, where the spinal cord and medulla oblongata intersect. The disease can cause pinching of nerve fibers and other structures in the bone ring, and this provokes improper functioning, stopping the activity of the centers responsible for vascular movement and breathing. This syndrome can cause death. An equally dangerous condition is a narrowing of the channel responsible for communicating with the cerebral ventricles. Some children from birth have underdeveloped openings intended for fluid outflow into the subarachnoid region.

Dangers lurk at every turn

A cyst developing in the subarachnoid space can cause hydrocephalus in children under one year of age. Improperly formed cerebral veins can provoke the disease. The peculiar Dandy-Walker syndrome is also known to medicine. This term refers to a condition in which the spaces for cerebellar fluid develop incorrectly, which leads to deformation of the fourth ventricle. Because of this change, a cyst of the fossa of the skull appears at the back, and the cerebellar vermis does not receive enough resources for full development.

It is known that hydrocephalus in children under one year of age is possible against the background of an oncological process in the child’s body. The disease can be triggered by infection with the papilloma virus, brain cancer, or tumors affecting the cerebral ventricles. Meningioma localized in the choroid plexus is extremely dangerous. Dropsy can be caused by tumors of the cranial bones or cancer affecting the spinal cord. With these pathologies, the flow and absorption of cerebrospinal fluid become difficult or impossible, which leads to hydrocephalus.

Risks. When is the danger greatest?

Most often, external, internal or mixed hydrocephalus is found in children born prematurely, before the 35th week of gestation. The risk group includes babies who are underweight (less than one and a half kilograms), as well as those whose mother’s pelvis is too narrow. The likelihood of dropsy is higher if the birth was carried out using auxiliary instruments - vacuum devices, forceps. Asphyxia, lack of oxygen, and problems with the baby's breathing at the time of birth are another factor that suggests a high risk of hydrocephalus. Infants who already had infected internal organs at birth, as well as those born to mothers who suffered from some kind of infectious or viral disease during pregnancy, are at risk. The list of such pathologies is quite wide, from flu and colds to mononucleosis and toxoplasmosis.

Internal and external hydrocephalus is more often diagnosed in children whose mothers were addicted to bad habits, if they were not given up during the period of bearing the child. For any of these factors, it is important to constantly monitor the baby’s condition, and at the first suspicion of pathological processes, you should consult a qualified doctor to monitor your health. Timely detection of pathological processes makes it possible to provide adequate assistance with little bloodshed.

Disease. What types are there?

In order for the treatment of hydrocephalus of the brain in children to give a quick and maximum result, it is important to make an accurate diagnosis, correctly determine for what reason the disorder developed, and what method of eliminating it is optimal for a particular case. To identify membership in a certain class, you will have to analyze a number of criteria, including the causes of the disease, indicators of pressure inside the skull, and the quality of the cerebrospinal fluid pathways. The doctor assesses at what point the disease appeared, and based on this, it is determined whether the pathology is acquired or congenital. Depending on the course, acute and chronic forms are distinguished. With the first, there is a sharp deterioration in the patient’s condition, as the pressure quickly increases. The patient becomes ill in just a few days. With chronic disease, blood pressure increases gradually, imperceptibly, and the duration of the disease is up to six months. More often, this course is characteristic of open dropsy. In addition, there is a subacute form, when the condition gradually becomes worse; the development of processes takes from a quarter of a year to six months. The consequences of the subacute form are very severe; brain structures suffer greatly if adequate help is not provided in time.

Based on certain symptoms, one can suspect hydrocephalus in a child, which develops in the open type. This type of disease is called a communicating disease. Liquor is produced and absorbed with different activity, which leads to an imbalance. There is a communication system between the ventricles; the cerebrospinal fluid enters the space between the meninges, where absorption should occur. The imbalance is provoked by meningitis, metastases, and can occur against the background of local hemorrhage in the brain tissue, sarcoidosis. There are cases when the open form was detected as a disease accompanying tumor processes in the choroid plexus. Closed dropsy is explained by a block in the pathways for the removal of cerebrospinal fluid, which leads to dilation of the ducts. This form is more common open, and its course is more severe. The disease can be provoked by stenosis, blockage of holes, hemorrhages, and cystic formations.

What else happens?

Doctors know what treatment should be for hydrocephalus in children if the disease develops according to the hyperproduction scenario. This pathology is caused by excess generation of cerebrospinal fluid. Another type of disease is aresorptive, in which fluid is formed in adequate volumes, but for various reasons is not absorbed. There is also a mixed type, in which the cerebrospinal fluid is both formed and absorbed, but the first process is more active than the second, which leads to an imbalance.

The external form of the disease is diagnosed if fluid accumulates between the meninges, but internal hydrocephalus in children is detected if accumulation processes occur in the ventricles, which gradually become overfilled. There is also a mixed type of disease, when there is no single location for the accumulation of cerebrospinal fluid.

Pressure and degree of pathology

The choice of treatment method for hydrocephalus in children is based on various features of the disease, including pressure levels inside the skull. It is customary to talk about a disease that occurs with normal, high and low blood pressure. The indicators are often maintained at normal levels at the very beginning of the disease, after which the pressure gradually increases. Hypotension with dropsy is extremely rare. In some cases, compensated hydrocephalus is observed. This disease is hidden, does not manifest itself with symptoms, and the baby functions normally. The decompensated option is a situation where health problems are obvious. All children after hydrocephalus face great difficulties in everyday life.

The division of the disease into degrees is known. To be assigned to a certain category, it is necessary to comprehensively analyze the patient’s condition. Data are obtained using CT and MRI methods, and analysis is carried out with a contrast agent. The results of the study help to identify moderate changes, when the brain structures are not too damaged by pathological processes, as well as pronounced ones, in which the pathways for the cerebrospinal fluid are larger than normal, the brain matter has undergone changes. The moderate form is considered extremely dangerous, since it is not accompanied by symptoms. Many parents believe that doctors are in vain causing panic, so they do not begin timely treatment of the child, and the disease worsens over time, sooner or later leading to a crisis state.

What to expect?

The consequences of brain hydrocephalus in children can be different, it all depends on the form of the disease and how quickly and correctly its treatment was started. The most favorable prognosis concerns the communicating form. Congenital forms are sometimes easier to tolerate than acquired ones. If the doctor took life-saving measures in time, the child lives a long life and develops normally, although the quality of everyday life may decrease. As a result of the disease, the functions of hearing, vision, and speech may be impaired. Sometimes there are difficulties in coordinating movements.

To avoid the consequences of cerebral hydrocephalus in children, preventive measures should be taken to prevent the development of the disease. The first and most important rule is to protect the baby’s head from various herbs, using helmets and car seats. You should avoid being in places where the risk of injury is higher. During pregnancy, you need to completely give up bad habits and undergo examination for possible infectious infections. If you have had an illness, even a simple acute respiratory viral infection, you should come to an appointment to check the condition of the fetus, and also consult with an infectious disease specialist or geneticist. A pregnant woman should consult a neurologist, undergo an MRI, and ultrasound. This is especially true if the baby is born prematurely.

How to notice the problem?

The symptoms of hydrocephalus in a child under two years of age differ from the manifestations observed in older children. The first option is more often a congenital form, which is difficult to tolerate and is accompanied by a sharp deterioration of the condition and damage to brain structures. It is known that such dropsy formed after meningitis, encephalitis, and developed according to a chronic scenario. The cranial bones in small children have not yet fused together, displacement is possible, so the key sign of hydrocephalus is an abnormal increase in the volume of the head. If measurements show a monthly increase of one and a half centimeters or more in the first quarter of a year of life, a disease can already be suspected. A problem can be suspected if the increase subsequently reaches 9 millimeters. Usually the circumference of a child's head is only a couple of centimeters larger than the circumference of the chest; by the age of six months the figures become the same, but with dropsy the head remains larger than the body.

The very first consequences of cerebral hydrocephalus in children, observed already during the course of the disease, are sleep disturbances, weight loss, and slow development. A sick child learns to hold his head up at the age of three months, sometimes later. Many are whiny, capricious, the skin on the head is thin, the wreaths are visible through it, and over time the integument begins to shine. A sick baby learns to sit and move later than healthy children, and a pliable pulsating place remains on top of the head. The baby's forehead is larger than normal, the child often throws his head back, eats rarely and little, and his eyelids are drooping. If the disease develops rapidly, urgent hospitalization is necessary. This can be noticed by a convulsive state, crying, craving for sleep, vomiting, and loss of previously acquired skills.

What to do?

There are two treatment options - surgical treatment (shunted hydrocephalus is often found in children), and medication. Conservative methods are possible if it was possible to identify the pathology at the very beginning. For the best prognosis, a neurosurgeon and a neuropathologist should work with the patient as a team. To reduce the pressure inside the skull, measures are taken to reduce the production of cerebrospinal fluid or enhance its absorption. The effectiveness of the product “Diakarb” is shown. The dosage should be chosen by the doctor, assessing the age and general condition of the patient. The active compounds of the drug stop the activity of enzymes responsible for the production of cerebrospinal fluid, activate urination, and help get rid of excess potassium in the tissues. To enhance the therapeutic approach, the child is prescribed the drugs “Asparkam” and “Panangin”. They are used simultaneously with Diacarb in the morning, on an empty stomach.

In some cases, products that help get rid of excess moisture in the body can be beneficial. These are some diuretics that affect the plasma, stimulating the transition of water from the brain to the vascular system and its subsequent excretion by the kidneys. Glycerin for oral administration and Mannitol and Furosemide have proven themselves well. These names show greater effectiveness in combination with Panangin and Asparkam. To improve the prognosis, the patient can be prescribed “Calcium hopantenate” and “Encephabol”, which have a positive effect on the brain at the neural level.

Need surgery!

If medicinal methods do not show sufficient effectiveness over a course duration of two to three months, it is necessary to resort to the surgical method. It is also irreplaceable if the disease develops in a closed form. Quite often the shunt method is used for hydrocephalus in children. There are many cases where surgery was the only way to stop the progress of the disease and prevent irreversible damage to brain structures. A specific method of operation is chosen, focusing on the age, general condition of the patient, and stage of the disease.

With a closed form, objects that are causing the cerebrospinal fluid to circulate incorrectly can be removed. This helps if the cause of the disease is tumor processes, hematomas, cysts, or aneurysms. The flow of cerebrospinal fluid returns to normal, the liquid flows to the points where it is absorbed. It is possible that the tumors have grown into the brain tissue or do not have clearly defined boundaries. Doctors then intervene to create an alternative pathway for the passage of cerebrospinal fluid. For this purpose shunting is done. A common practice is to drain fluid through silicone catheters into the abdominal cavity to the films lining the organ from the inside - they are characterized by increased absorption capacity. As can be seen from medical statistics, such an operation is performed at least 200,000 times annually in different countries of the world. The invention of this method saved a huge number of lives.

Alternative options

Another method of shunting involves diverting cerebrospinal fluid into the atrium on the right. In this case, doctors direct artificial vessels so that the liquid enters the tank intended for it in the back of the head. Another way is the connection of the peritoneum and the canal for the spinal cord. In some cases, it is possible to avoid the use of silicone tubes if it is possible to use an endoscope to create outflow tracts. This term is usually used to designate a fiber-optic tube, with the help of which minimally invasive operations have become possible, much easier to tolerate by patients than traditional methods of surgical intervention.