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Early presentation helps in treatment of hydrocephalus

By Paul Adunwoke
21 October 2018   |   3:22 am
As World Hydrocephalous Day comes up on Wednesday October 25 2018, parents have been advised to seek for help early, as there should be no delay once diagnosis is made. Effort should be made to go to hospital within 48 hours.

As World Hydrocephalous Day comes up on Wednesday October 25 2018, parents have been advised to seek for help early, as there should be no delay once diagnosis is made. Effort should be made to go to hospital within 48 hours.

Health experts explained that parents should seek second opinion, as the condition is very treatable with good outcome when diagnosis is made early. When in doubt of the disease especially, when the head is getting bigger, computed tomography (CT) scan of the brain will help in terms of treatments.

Dr. Omotayo Ojo, a Consultant Neurosurgeon at Lagos University Teaching Hospital (LUTH), described hydrocephalus as abnormal accumulation of fluid within the brain cavity.

He said: “Human beings normally produce cerebrospinal fluid in the brain. This fluid serves the function of removing waste products from the brain, as well as giving brain suspension, so that the brain is free from bumping into the skull and not feeling too heavy.

“This fluid has a pathway by which it exits the brain. When the pathway Optical imaging of intrinsic signals (OIS) is blocked by whatever reason, the fluid will accumulate and the brain tissue will get smaller and the head, especially in children will get bigger.”

Ojo explained that about 550ml of cerebrospinal fluid (CSF) is produced daily and 350ml is absorbed, leaving 100ml to 150ml in circulation. With obstruction, about 350 that should be absorbed will be added to the brain chamber, thereby causing significant neurologic sequelae.

“The causes of hydrocephalus remain the fact that infection is the commonest in our region. Infection like meningitis can also cause hydrocephalus. Other causes include congenital tumours, among others.

“The signs and symptoms of hydrocephalus include refusal of food, increasing head circumference on daily basis, large head out of proportion, bulging head, vomiting, inability to sit down, stand or walk and general body weakness, among others.

“Hydrocephalus affects children right from first week of life till about two years. It can also happen at any age including adulthood.” So, what can government do in the prevention of hydrocephalus? “Government can embark on awareness programmes that the disease is treatable and not some form of spiritual attack, and that results are better when treated early. Government can also subsidise treatment for children,” he said.

Dr. Chukwuma Ogunbor, a Family Physician said clinical features of hydrocephalus are influenced by the patient’s age, the cause of the hydrocephalus, location of the obstruction, its duration, and rapidity of onset. He said: “Symptoms in infants include poor feeding, irritability, reduced activity, and vomiting. Preventing head injuries, which can also lead to hydrocephalus, helps to reduce the risk of developing “water in the brain.” Vaccinating children against meningitis, a cause of hydrocephalus, is also a consideration for parents.

“You can’t prevent hydrocephalus, but you can lower your child’s risk for developing the condition. Make sure you get prenatal care during pregnancy. This can help reduce the chance of going into premature labour, which can lead to hydrocephalus. “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, the future for many is promising. Recent research is advancing knowledge and moving us closer to a cure. Advances in technology, as well as diagnostic and treatment protocols are helping more people with hydrocephalus to lead full and active lives.”

Ogunbor explained that there are currently three forms of surgical treatment used to manage hydrocephalus.He said: “The most common treatment for hydrocephalus and the most common procedure performed by pediatric neurosurgeons in the United States is the surgical implantation of a device called a shunt. A shunt is a flexible tube placed into the ventricular system of the brain, which diverts the flow of CSF into another region of the body, most often the abdominal cavity, where it can be absorbed. A valve within the shunt maintains CSF at normal pressure within the ventricles.

“A second treatment option for hydrocephalus is a surgical procedure called Endoscopic Third Ventriculostomy (ETV). The ETV procedure with the addition of choroid plexus cauterisation is available for infants. In the ETV procedure, an endoscope is used to puncture a membrane in the floor of the third ventricle creating a pathway for CSF flow within the brain cavities. This approach is an important alternative to shunting for obstructive hydrocephalus and may also be useful in other cases.

“The third treatment option involves the addition of choroid plexus cauterisation (CPC), with endoscopic third ventriculostomy in infants. The neurosurgeon uses a device to burn or cauterise tissue from the choroid plexus. The choroid plexus is a network of vessels in the brain ventricles, where cerebrospinal fluid is produced.”

Ogunbor said success rate for ETV or ETV/CPC depends upon such patient factors as age, cause of hydrocephalus, and whether there is scarring in the fluid space below the floor of the third ventricle. He said: “For some patients, the chance for ETV success may be up to 90 percent. However, for others, ETV with the addition of CPC for infants may not be recommended, because the chances for success are sufficiently low.
“Your neurosurgeon should be able to provide you with a reliable estimate of the likelihood for success in your particular situation prior to operation. “It is critical that parents and patients understand that ETV is not always a permanent cure for hydrocephalus. Candid communication with your physician regarding the definition of success is important, when considering ETV.”

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