English
Türkçe
Fatma Girik, a distinguished name in Turkish Cinema, recently underwent surgery. After extensive tests to investigate the cause of her frequent falls, it was decided that Girik should undergo surgery. We asked Dr. Tolga Dündar, a neurosurgery specialist, whether the disease known in medicine as Hydrocephalus, which means the accumulation of water in the brain and led Girik to have a shunt surgery, poses a fatal risk. Here is everything you need to know about Hydrocephalus…
1- What is Hydrocephalus?
Hydrocephalus is a term derived from the combination of the words hydro=water and cephalus=head. It is generally known as an excessive accumulation of fluid in the brain. The water mentioned here refers to cerebrospinal fluid. This fluid is continuously produced and absorbed throughout the day, enveloping the brain and spinal cord, and it circulates constantly. It has three main functions: to reduce the harmful impact of blows to the brain and spinal cord, to assist in the nutrition of the brain and the transportation of waste, and to regulate changes in pressure within the brain by circulating between the brain and spinal cord.
An increase in the volume of this fluid in the spaces it fills can lead to an increase in pressure inside the skull and damage to nerve tissue, thereby potentially affecting daily life and intellectual behavior.
Hydrocephalus can be seen at any age, but it is most common in children and the elderly (over 60 years old). Hydrocephalus is seen in approximately one out of every 500 children. In most of these patients, the diagnosis can be made at birth, before birth, or in early infancy.
2- What are the symptoms?
The signs of hydrocephalus vary depending on age, the length of time until diagnosis, and the cause. Common findings by age groups are specified below.
In the Newborn period (0-2 months); abnormal growth of the head size according to measurements or family notice, thinning of the scalp, pronounced veins on the head, vomiting, tension in the fontanelle called the soft spot, restlessness, downward deviation of the eyes, seizures, or inability to communicate may be seen.
In Children (2 months and above); abnormal growth of the head, headache, nausea, vomiting, fever, double vision, restlessness, regression in walking or speaking, communication disorders, loss of motor function, seizures, drowsiness. Difficulty in staying awake or waking up may be seen in older children.
In Middle-aged adults; headache, difficulty in waking up or staying awake, balance disorder, incontinence, personality disorder, dementia, visual impairment, slowing of movements may be seen.
In the Elderly; communication disorders, imbalance in walking, difficulty in remembering, headache, incontinence, gait disorder may be seen. Sometimes it can be confused with Alzheimer’s disease.
3- Who are in the risk group?
The risk of hydrocephalus varies according to age groups.
Newborns (0-2 months): Nutritional deficiency of the mother; children of mothers, especially those with a deficiency in folic acid, constitute the largest risk group. It may occur alone or together with other congenital disorders developing in the spine (Meningomyelocele refers to the disruption occurring in the spinal cord and spine before birth). This age group is prone to intracranial bleeding. This can be caused either by birth trauma or the lack of development of clotting factors. Typically, expansion in the brain ventricles is seen following spontaneous bleeding. This bleeding can both disrupt absorption and block the circulation of cerebrospinal fluid.
Children and Adults: Brain infections, brain hemorrhages, brain tumors, and head traumas are most commonly seen in this group. These causes are significant reasons for hydrocephalus.
Elderly: Normal-pressure hydrocephalus is most commonly seen in this group. Both a decrease in the absorption of cerebrospinal fluid and shrinkage of brain tissue with age can cause ventricles to expand.
4- How is the diagnosis made, and what methods are used?
Radiological examinations play an important role in making a diagnosis and directing treatment. Ultrasonography (USG), computed brain tomography (CT), Magnetic Resonance Imaging (MRI), and in some selected cases, the nuclear medicine method of Positron Emission Tomography (PET) can be used.
5- Types of Treatment
Medical: There is no effective drug treatment. There are some drugs aimed at reducing the production of cerebrospinal fluid or increasing its absorption, but their effectiveness is quite limited.
Surgical: Removal of the obstructive lesion; if the cause of the obstruction is a tumor, tumor excision, if cystic structures, cyst excisions, or if hemorrhages in the brainstem and cerebellum, draining these hemorrhages form the basis of surgical treatment.
Bypassing the site of obstruction can also be done with a technique called 3rd Ventriculostomy (Endoscopic, stereotactic, open surgery).
Shunt surgeries: There are many varieties such as Ventriculoperitoneal (from inside the brain to the abdominal cavity), Ventriculoatrial (from inside the brain directly to the heart), Ventriculopleural (from inside the brain to between the lung membranes), Lumboperitoneal (from inside the spinal cord in the lumbar region to the abdominal cavity), Ventriculosubgaleal (from inside the brain to under the skull scalp membranes). The method is chosen according to clinical necessities.
6- Can Hydrocephalus lead to death?
The brain tissue is in a closed area within the skull. An increase in the existing fluid content will increase the pressure in this closed area, thus causing nerve damage. This situation can present clinically as respiratory arrest, slowing of the heartbeat, and high blood pressure. If these are not intervened early, the process can result in death.
Note: This article was originally written in Turkish and has been translated into English by us. To read the original, please visit local news website: Milliyet
