Hydrocephalus is a condition in which excess of CSF accumulates within the ventricular system leading to increased intracranial pressure. Hydrocephalus occurs due to imbalance between the production of CSF and its absorption.
Hydrocephalus in children is a very common problem encountered by pediatricians , surgeons and neurosurgeons.The folic acid vitamin supplements in antenatal period and antenatal care including ultrasonography have diminished the incidence of neural tube defects and pediatric hydrocephalus.
The clinical presentation of pediatric hydrocephalus are those of raised intracranial pressure, which vary with age.
An infant with open sutures usually present with a gradually increasing head circumference. The most common finding will be the large head size.Irritability, vomiting , eye movement abnormalities like downward deviation of the eyes ( " sunsetting" sign ) or the sixth nerve paresis are other common finding. The percussion over the skull may produce a "cracked pot sign." The veins of the scalp may be very prominent. here will be sutural diastasis. Anterior fontenelle is bulging and brain pulsations may be obvious.
As the child gets older and sutures fuse, the presentation differs. The head size may still be large for that age. Child may complain of headache , nausea and vomiting . On examination there may be papilledema and visual deficit. papilledema may occur in long standing cases.
Presentation beyond the first few years of life usually suggests hydrocephalus secondary to an acquired disorder such as tumor, infection ( meningitis) or head injury.
The common causes of Congenital hydrocephalus( Hydrocephalus presents soon after birth) are Aqueduct stenosis, Dandy Walker syndrome, Holoprosencephaly, generalized malformation of brain development.
Myelomeningocele and meningocele may be associate with Arnold Chiari malformation and Hydrocephalus.
Other common causes of hydrocephalus in pediatric age group are:
Arachnoid cyst,
Post hemorrhagic hydrocephalus due to intraventricular hemorrhage in a premature infant
Hydrocephaus associated with brain tumors like Craniopharyngioma, Pineal tumor, Medulloblastoma and posterior fossa Ependymoma.
Post traumatic hydrocephalus
Post meningitic hydrocephalus ( Pyogenic Meningitis, Viral Meningitis or Tubercular ) or post infective like granulomas compressing over the ventricle ( Tuberculoma, Neurocysticercus) or abcess.
Choroid plexus papilloma causes hydrocephalus mainly due to excessive production of CSF.
Management of Hydrocephalus may begin with the antenatal care and advising ultrasonography.
MRI of the brain and spine should be done if there is any suspicion of Arnold Chiari malformation to diagnose associated split cord malformation, Syringomyelia, congenital dermal sinus.
Monitoring of the patient and conservative trial of treatment with cerebral decongestants are sufficient to treat a majority of pediatric patients with hydrocephalus and surgery for the CSF diversion procedure is not required.
Ventriculoperitoneal Shunt surgery ( VP shunt) is very common surgery for the treatment of hydrocephalus. Endoscopic third ventriculostomy is another option to treat hydrocephalus where an opening is made in the floor of third ventricle and CSF pathway is opened from third ventricle to the pre pontine cistern.
Hydrocephalus in children is a very common problem encountered by pediatricians , surgeons and neurosurgeons.The folic acid vitamin supplements in antenatal period and antenatal care including ultrasonography have diminished the incidence of neural tube defects and pediatric hydrocephalus.
The clinical presentation of pediatric hydrocephalus are those of raised intracranial pressure, which vary with age.
An infant with open sutures usually present with a gradually increasing head circumference. The most common finding will be the large head size.Irritability, vomiting , eye movement abnormalities like downward deviation of the eyes ( " sunsetting" sign ) or the sixth nerve paresis are other common finding. The percussion over the skull may produce a "cracked pot sign." The veins of the scalp may be very prominent. here will be sutural diastasis. Anterior fontenelle is bulging and brain pulsations may be obvious.
As the child gets older and sutures fuse, the presentation differs. The head size may still be large for that age. Child may complain of headache , nausea and vomiting . On examination there may be papilledema and visual deficit. papilledema may occur in long standing cases.
Presentation beyond the first few years of life usually suggests hydrocephalus secondary to an acquired disorder such as tumor, infection ( meningitis) or head injury.
The common causes of Congenital hydrocephalus( Hydrocephalus presents soon after birth) are Aqueduct stenosis, Dandy Walker syndrome, Holoprosencephaly, generalized malformation of brain development.
Myelomeningocele and meningocele may be associate with Arnold Chiari malformation and Hydrocephalus.
Other common causes of hydrocephalus in pediatric age group are:
Arachnoid cyst,
Post hemorrhagic hydrocephalus due to intraventricular hemorrhage in a premature infant
Hydrocephaus associated with brain tumors like Craniopharyngioma, Pineal tumor, Medulloblastoma and posterior fossa Ependymoma.
Post traumatic hydrocephalus
Post meningitic hydrocephalus ( Pyogenic Meningitis, Viral Meningitis or Tubercular ) or post infective like granulomas compressing over the ventricle ( Tuberculoma, Neurocysticercus) or abcess.
Choroid plexus papilloma causes hydrocephalus mainly due to excessive production of CSF.
Management of Hydrocephalus may begin with the antenatal care and advising ultrasonography.
MRI of the brain and spine should be done if there is any suspicion of Arnold Chiari malformation to diagnose associated split cord malformation, Syringomyelia, congenital dermal sinus.
Monitoring of the patient and conservative trial of treatment with cerebral decongestants are sufficient to treat a majority of pediatric patients with hydrocephalus and surgery for the CSF diversion procedure is not required.
Ventriculoperitoneal Shunt surgery ( VP shunt) is very common surgery for the treatment of hydrocephalus. Endoscopic third ventriculostomy is another option to treat hydrocephalus where an opening is made in the floor of third ventricle and CSF pathway is opened from third ventricle to the pre pontine cistern.
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