From the Guidelines
Hydrocephalus is a condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain, leading to increased intracranial pressure, and its pathophysiology involves an imbalance between CSF production and absorption, as noted in the 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage 1. The definition of hydrocephalus is crucial for understanding its impact on patient outcomes, including morbidity, mortality, and quality of life.
Key Points
- Hydrocephalus can result from overproduction of CSF, obstruction of CSF flow, or impaired absorption, with the latter two being more common, as seen in conditions like meningitis or subarachnoid hemorrhage 1.
- The condition is characterized by increased intracranial pressure, ventricular enlargement, and compression of surrounding brain tissue, leading to neurological symptoms such as headache, vomiting, altered consciousness, gait disturbances, and cognitive impairment.
- Treatment typically involves surgical placement of a shunt system to divert excess CSF from the ventricles to another body cavity, such as the peritoneum, where it can be absorbed, as recommended in the 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage 1.
Pathophysiology
The pathophysiology of hydrocephalus involves an imbalance between CSF production and absorption.
- CSF is normally produced by the choroid plexus in the ventricles and circulates through the ventricular system before being absorbed into the bloodstream via arachnoid granulations.
- In hydrocephalus, this balance is disrupted, leading to an accumulation of CSF and increased intracranial pressure.
Diagnosis and Treatment
Diagnosis of hydrocephalus typically involves imaging studies such as MRI or CT scans to visualize ventricular enlargement and assess for any obstructions or abnormalities in CSF flow.
- Treatment, as mentioned, usually involves the placement of a shunt system to divert excess CSF and reduce intracranial pressure, with the goal of improving neurological outcomes and quality of life, as emphasized in the 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage 1.
From the Research
Definition of Hydrocephalus
- Hydrocephalus is a condition characterized by an accumulation of cerebrospinal fluid (CSF) in the brain, leading to increased intracranial pressure 2, 3, 4, 5, 6.
- The condition can be caused by various factors, including congenital lesions, tumors, and posthemorrhagic hydrocephalus in premature infants 3, 5, 6.
Pathophysiology of Hydrocephalus
- The pathophysiology of hydrocephalus involves the disruption of normal CSF circulation and absorption, leading to an accumulation of CSF in the ventricles and subarachnoid space 2, 4.
- The condition can be classified into different types, including normal pressure hydrocephalus, which is characterized by a radiographic pattern of disproportionately enlarged subarachnoid space hydrocephalus (DESH) 2.
- The management of hydrocephalus involves the use of CSF shunts or endoscopic third ventriculostomy (ETV) to divert CSF and reduce intracranial pressure 3, 4, 5.
Treatment Options for Hydrocephalus
- CSF shunts and ETV are both effective treatment options for hydrocephalus, with equivalent outcomes in certain clinical etiologies 5.
- The choice of treatment depends on various factors, including the underlying cause of hydrocephalus, patient age, and clinical judgment 3, 4, 5, 6.
- Ventricular access devices, external ventricular drains, and lumbar punctures are also used as temporizing measures in the management of posthemorrhagic hydrocephalus in premature infants 6.