استسقاء الرأس لدى الأطفال: التشخيص وخيارات العلاج والإدارة طويلة الأمد

Hydrocephalus—literally “water on the brain”—is a condition where cerebrospinal fluid (CSF) builds up in the brain’s ventricles. In children, it can lead to increased intracranial pressure, developmental delays, and neurological deficits if not treated properly. In this article, we will explain how hydrocephalus is diagnosed in children, review surgical treatment options (with pros and cons), and discuss long-term care and follow-up strategies.

Signs & Symptoms of Pediatric Hydrocephalus

The manifestations of hydrocephalus differ depending on the child’s age:

• Infants and Young Babies
  • Rapid increase in head circumference, bulging fontanelle (soft spot), sunsetting eyes (eyes deviate downward), vomiting, poor feeding, irritability, seizures.
• Older Children / School Age
  • Headache, nausea/vomiting, difficulty with balance or walking, vision problems, behavioral changes, cognitive decline, urinary incontinence.
• Adolescents
  • Headache, cognitive problems, gait disturbance, fatigue.

Prompt recognition is crucial to prevent irreversible brain damage.

Diagnostic Workup

1. Clinical Evaluation
   • Head measurement and growth charts (especially in infants).
   • Neurological exam, developmental assessment, ocular examination (to check papilledema).
2. Neuroimaging
   • MRI is preferred, showing ventricular enlargement, transependymal flow, and associated structural abnormalities (e.g. Chiari malformations, aqueductal stenosis).
   • CT may be used in emergencies.
3. ICP Monitoring / Lumbar Puncture (in selected cases)
   • In ambiguous cases, pressure monitoring or dynamic studies may help.

خيارات العلاج

A. Ventriculoperitoneal (VP) Shunt

• How it Works
  A catheter drains CSF from the ventricles to the peritoneal cavity, where the fluid is absorbed.
• Advantages
  Well-established technique; familiar to most neurosurgeons; adjustable valves available.
• Disadvantages / Risks
  Shunt malfunction (blockage), infection, overdrainage (leading to subdural hematomas), and the need for revisions over time.

B. Endoscopic Third Ventriculostomy (ETV) ± Choroid Plexus Cauterization

• How it Works
  A small endoscopic perforation is made at the floor of the third ventricle to create a pathway for CSF to bypass obstructions and be reabsorbed.
  Sometimes choroid plexus cauterization is performed to reduce CSF production in selected pediatric cases.
• Advantages
  No foreign hardware (reduces infection/shunt dependency), fewer long-term revisions in properly selected patients.
• Limitations / Risks
  ETV fails in some infants (esp. < 6 months), scarring may block stoma over time, it’s not suitable in communicating hydrocephalus.
  Requires precise patient selection and surgical expertise.

C. Combined or Hybrid Techniques

• In certain cases, both shunting and endoscopy might be used, for example ETV with backup shunt placement, or staged approaches, depending on anatomy and risk.

The decision depends on multiple factors: age, hydrocephalus type (obstructive vs. communicating), previous shunt history, anatomy (ventricular size, obstructions), risk factors, and surgeon experience. At Dr. Dundar’s institution, each child is evaluated through a multidisciplinary team, and the approach is customized.

Postoperative Care & Monitoring

• Early Postop
  Monitor for signs of increased intracranial pressure (vomiting, lethargy, bulging fontanelle), infection (fever, irritability), or fluid overdrainage.
• Long-Term Follow-Up
  Regular neuroimaging, head measurement (in infants), developmental assessments, neuropsychological follow-up, etc.
• Shunt/Procedure Surveillance
  Educate the family about signs of shunt malfunction or infection (headache, vomiting, altered consciousness), which require emergency evaluation.
• Rehabilitation & Support
  Some children may need physical therapy, occupational therapy, speech therapy, educational support, and neurodevelopmental services.

With timely diagnosis and treatment, many children can lead healthy lives, though outcomes depend on underlying brain health, timing of intervention, associated neurological injuries, and long-term monitoring. Lifelong follow-up is often required. Advances in neurosurgical techniques, imaging, and child neurology continue to improve outcomes.