definition of hydrocephalus, types of hydrocephalus, communicating and non communicating hydrocephalus, csf, different treatments of the hydrocephalus, different types of shunts, VP shunt, causes of hydrocephalus, normal pressure hydrocephalus NPH, slit ventricle syndrome, ETV

1. HYDROCEPHALUS
DR SANA YASEEN
ANATOMY DEPARTMENT
JMDC

2. OBJECTIVES
Define hydrocephalus
List common symptoms and signs of acute hydrocephalus in children
List common symptoms and signs of normal pressure hydrocephalus in adults
Define communicating and non-communicating hydrocephalus
Describe the differences in the treatment

3. CSF
Normal intracranial pressure in resting state: 10mmhg (8-15mmhg)
Normal volume : 150ml
Formation: choroid plexus
Drainage: venous sinuses

4. HYDROCEPHALUS
Is an abnormal increase in the volme of CSF within brain/ skull
CAUSES :
I. Blockage of circulation of fluid
II. Abnormal increase in the formation of fluid
III. Decrease absorption of the fluid
IV. Normal pressure hydrocephalus

6. TYPES OF HYDROCEPHALUS
I. Communicating / non obstructive
II. Non communicating / obstructive

7. NON- COMMUNICATING HYDROCEPHALUS
 Occurs due to blockage of the flow at some point between its
formation and its exist through foramens into subarachnoid space. (
blockage of ventricular system)
Causes:
 tumor/ mass (tactal plate glioma/ colloid cyst)
Cerebellar abcess/ hematoma
Congenital aqueduct stenosis
Arnold chiari syndrome

8.  CLINICAL PRESENTATION:
Acute Obstruction:
-Sudden increase in IVP leads to unconsciousness and even death
Chronic obstruction:
-There may be no symptoms despite massive dilation of ventricles
-Headache, nausea, vomiting, papilledema
-Inchildren when sutures are not fused may lead to elargement of head
Diagnosis :
LP is contra indicated
CT
MRI

10. COMMUNICATING HYDROCEPHALUS
Csf flow within the ventricles is patent and the obstruction is present outside the ventricular
system
Or there is excessive fluid formation
CAUSES:
 inflammatory exudate- bacterial meningitis
Venous thrombosis
Subarachnoid hemorrhage
Head injury
 obstruction of IJV
sarcoidosis
Diagnosis:
Lumpbar puncture
CT
MRI

13. NORMAL PRESSURE HYDROCEPHALUS
Is the type of communicating hydrocephalus
Commonly seen in elderly patient
Actual cause is unknown
May be idiopathic, meningitis, head trauma
Ventriculomegaly is present
In adults triad signs are seen
Ataxia
Dementia
Urinary incontinence
Diagnosis: CSF TAP, MRI
 Gradual onset after age
40 years, symptoms
duration of ≥ 3–6 months.

16. Imaging from (MRI) or (CT) is needed to demonstrate enlarged ventricles and no
macroscopic obstruction to cerebrospinal fluid flow. Imaging should show an
enlargement to at least one of the temporal horns of lateral ventricles, and impingement
against the falx cerebri resulting in a callosal angle ≤ 90° on the coronal view, showing
evidence of altered brain water content, or normal active flow (which is referred to as
"flow void") at the cerebral aqueduct and fourth ventricle.

17. TREATMENT
First line is to treat the cause.
Placement of shunt
TYPES OF SHUNT:
Ventriculo- peritoneal shunt
Ventriculo-atrial shunt
Ventriculo-pleural shunt

18. VP Shunt

19. VENTRICULOPERITONEAL SHUNT
Cather is placed into lateral ventricle
Catheter is then connected to shunt valve under the scalp and is
connected to distal catherter
Distal catheter is tunneled subcutaneously down to abdomen and
inserted to peritoneal cavity
If CSF pressure exceeds shunt valve pressure then CSF will flow out of
distal catherter and absorbed by the peritoneal cavity

21. COMPLICATIONS:
Shunt blockage : choroid plexus adhesions, blood, cellular debris ,
misplacement of distal catherter
Shunt infection: e.staphlococcus epdidermidis, e.coli and haemolytic
streptococcal infection( in infants)
Over drain of shunt system leading to sub dural hematoma/ slit
ventricle syndrome
Seizures
CSF leakage
Stroke
Intra cerebral hemorrhage

22. SLIT VENTRICLE
SYNDROME
Slit ventricle syndrome is a
complication that occurs after
years of overshunting in
patients who had a ventricular
shunt placed as an infant. The
disease is characterized by
severe, life-modifying
headaches with normal or
smaller-than-normal
ventricles.

23. Endoscopic third ventriculostomy
(ETV)
ETV is a minimally-invasive procedure
is a surgical procedure for treatment of hydrocephalus in which
an opening is created in the floor of the third ventricle using an
endoscope placed within the ventricular system through a burr
hole.
 This allows the cerebrospinal fluid to flow directly to the basal
cisterns, bypassing the obstruction.
Specifically, the opening is created in the translucent tuber
cinereum on the third ventricular floor.

28. Advantages
•No foreign object (shunt tubing and
valve) implanted in the body, lowering
the risk of infection.
•Fewer incisions mean slightly less
discomfort.
•A lower long term complication rate
compared to a shunt.
•Useful in the obstruction below level of
third ventricle
Disadvantages
•The chances of improving may be lower
with ETV compared to a shunt
•Although very unlikely, the risk of
serious complications with ETV
compared to a shunt operation.