Hydrocephalus of the brain in children symptoms. Dropsy (hydrocephalus) of the brain in infants: causes of the disease and methods of medical intervention. How is hydrocephalus formed in a child?

Hydrocephalus of the brain in children is a serious disease that, if left untreated, may lead to fatal outcome.

general information

Hydrocephalus of the brain is accumulation of cerebrospinal fluid in the brain. Liquor is a liquid that delivers nutrients to the brain and saturates it with necessary substances.

However, for certain reasons, this fluid can stagnate, accumulate in the ventricles or under the membranes of the brain. The disease leads to delayed development of the child, serious condition, and hospitalization.

If treatment is not started in time, death will occur.

The disease is characterized primarily by an increase in the size of the child's head. With regular visits to the doctor, it is possible to diagnose the disease in the early stages of development.

Development mechanism

Liquor constantly circulates in the tissues of the brain, but for a number of reasons it stagnates. At this moment, brain tissue not getting the nutrition they need, and liquid accumulates. It prevents the brain from functioning properly.

The ventricles of the brain stop doing their job correctly, which leads to improper functioning of the entire nervous system.

The fluid can accumulate for a long time; over time, the baby’s head will increase in size and the condition will worsen.

The accumulation of large amounts of fluid will lead to improper functioning of the entire brain and later death.

The disease develops over several months, the first signs go unnoticed by others. That is why treatment usually begins at later stages diseases.

For diagnosis and treatment hemolytic disease You will find newborns on our website.

Causes and risk factors

The causes of this pathology are:

1. Premature birth. The fetal brain is not fully formed. Fluid (cerebrospinal fluid) may not circulate properly.
2. Head injury child at the time of birth. The baby's head could have been damaged at this moment, which would lead to fluid accumulation in the brain tissue.
3. Mother's illnesses during pregnancy. If she has suffered a serious illness, the fetus may have complications.
4. Smoking mother while carrying a child. Bad habits can provoke this disease.
5. Transferred by a child infectious diseases. If the baby had a serious illness, complications will arise. Hydrocephalus is one of the negative consequences.
6. Cardiovascular diseases child. May lead to brain disease.

Classification of the disease

Doctors distinguish two forms of the disease:

• moderate. The disease is controlled by a doctor. Symptoms gradually disappear and the fluid decreases. The patient is recovering;
• heavy. The disease continues to progress despite treatment. The child's condition is life-threatening. Hospitalization required.

There are two types of hydrocephalus:

• congenital. The first rudiments of the disease appeared in the fetus even before birth. Afterwards they developed. It is very difficult to treat and requires serious treatment;
• acquired. The child was born healthy, but after suffering from illnesses he developed hydrocephalus. It is much easier to treat this type of disease; medications prescribed by a doctor usually help.

Symptoms

Symptoms of the disease may vary depending on the age of the child. In newborns the disease manifests itself as follows:

1. Increase in head size. It grows by about 1 cm per month.
2. Developmental delay. The child has not developed some reflexes.
3. Regurgitation food. The baby spits out the breast milk and does not feel hungry.
4. Convulsions. The child often trembles, convulsions intensify.
5. Moodiness. The child cries because of pain in the head and discomfort.

In children older The disease manifests itself differently:

1. Vomit, nausea. The body does not absorb food as it should. The child may lose weight and not feel hungry.
2. Dizziness, weakness. The baby has no energy, so he lies down a lot and finds it difficult to complete complex tasks.
3. Head slightly increases at the rate of. The veins on the head may also enlarge and become more visible.
4. Memory is impaired. The child has difficulty concentrating on homework, text.
5. Sleep problems. It is very difficult for the baby to fall asleep, he does not get enough sleep, and feels tired.

Consequences and complications

If treatment is not started in time, you may encounter the following complications:

1. Weakness of the muscles of the upper and lower limbs. For this reason, the child difficult to move. He gets tired quickly.
2. Dysregulation of body temperature. The child quite often temperature rises.
3. Hearing impairment. Problems arise with the perception of sounds.
4. Dyspnea, problems with the respiratory system. Breathing becomes heavy.
5. Impaired functioning heart and blood vessels. This manifests itself as pain in chest, weakness.
6. Risk fatal outcome. Increases with the progression of the disease.

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Diagnostics

It is impossible to diagnose the disease yourself.

Need a doctor's help. The following methods are used to establish a diagnosis:

1. Inspection child. The specialist examines the baby’s appearance and head size.
2. CT scan. The brain is examined and the disorders can be examined in detail.
3. Monitoring. Is one of the most effective methods. Allows you to study the focus and determine the stage of the disease.

These methods help to quickly identify the disease and prescribe appropriate medications.

Treatment

There are several treatment methods for this disease.

Medicines

To combat excess fluid, Diacarb is prescribed.

It is made in tablet form. It is taken 1-2 times a day depending on the stage of the disease. The duration of treatment is determined by the doctor.

To eliminate the symptoms of the disease, improve blood circulation in the brain, It is recommended to use the following drugs:

• Cavinton;
• Pantogam;
• Asparkam.

Medicines are taken morning and evening in the dosage prescribed by the doctor.

The drugs quickly lead to an improvement in the child’s condition.

Vitamin B6 discharged in the early stages of the disease.

It helps eliminate the disease and improves the circulation of cerebrospinal fluid in the brain. Take intermittently. The course lasts two weeks, after which there is a break of a week. The exact dosage is determined by the doctor.

Osteopathy

If medications do not help you recover, more effective methods.

Osteopathy fights first of all with the cause of the disease, with its rudiments, and not with the symptoms.

Osteopathic doctor massages specific points of the body, which are very important in the human body. The specialist gently massages the child’s head, neck, and part of the back.

The doctor sets certain points after examining the baby. The duration of one session is 20-30 minutes. To achieve the desired effect, you must visit a doctor at least twice a week.

Bypass surgery

This surgery in order to remove excess fluid from the child’s brain.

This method allows not only to remove fluid accumulations, but also to normalize its normal circulation.

Represents the creation of fluid outflow pathways thanks to installation of a system of thin polymer hoses. Lasts this procedure from thirty to sixty minutes.

It all depends on the degree of the disease and the amount of fluid. However, it is worth understanding that serious violations This technique does not eliminate. She is able to cure a child only in the early stages of the disease.

To use this method, you need a doctor's referral and serious reasons. The technique is used only if medications have not brought the desired result.

Neuroendoscopic operations

Have wide application. Prescribed in 80% of cases. This major operations, which are accompanied by the removal of fluid and elimination of the cause of the pathology.

This method helps even in the later stages. The duration of the operation is from 50 to 80 minutes. Anesthesia and anesthesia are usually used.

Happening long recovery after surgery, it may take up to one month. However, after such an operation the disease does not appear again.

Forecast

With timely treatment, prognosis positive.

The child recovers after a few months.

This disease cannot be cured quickly. After recovery he can lead normal life . no different from their peers.

However, if left untreated, death can occur. It is imperative to show your baby to a doctor.

This disease is very dangerous for the child's body. If appropriate measures are not taken, you may encounter very serious consequences, so urgent treatment is necessary.

Pediatricians for treatment inguinal hernia for boys you will find on our website.

You can learn about the treatment of hydrocephalus in children from the video:

We kindly ask you not to self-medicate. Make an appointment with a doctor!

One of the dangerous and serious illnesses considered to be dropsy or hydrocephalus of the brain. The disease can occur in newborns, children over one year old and schoolchildren. There are many reasons for the formation of the disease, and they differ depending on the age when the pathology appeared. Timely treatment helps to cope with the disease and prevent the development of serious complications.

What is hydrocephalus of the brain in children

Dropsy or scientifically hydrocephalus is literally translated as water in the brain. The disease occurs when there is excessive accumulation of fluid in the liquor-conducting tract, which leads to an increase in cranial pressure, compression of brain structures. Congenital hydrocephalus in a child leads to an enlarged skull. The disease is difficult to recognize in time, which is why dropsy can be fatal.

How is hydrocephalus formed in a child?

The brain has several cavities called ventricles. They consist of bone tissue lined with plexuses of small vessels responsible for the transformation of cerebrospinal fluid (CSF). The ventricles are interconnected, so cerebrospinal fluid flows freely from one cavity to another and into the subarachnoid space (the cavity between the membranes of the brain). In this space there are vessels that absorb excess cerebrospinal fluid and metabolites released by the brain.

Liquor performs many important functions. It nourishes the ventricles of the brain, protects against infections, and normalizes cranial pressure. The liquid is synthesized continuously, depending on age: from 40 to 150 ml per day. If for some reason the amount of cerebrospinal fluid exceeds the norm, hydrocephalus develops in the child, the outflow of fluid occurs with difficulty, the brain structures are compressed and work abnormally.

Types of hydrocephalus

Dropsy is classified according to etiological, morphological and clinical signs. Depending on the time of appearance, the disease can be congenital (it is such if it begins to develop even before the baby is born) or acquired (diagnosed some time after birth). According to morphological characteristics, the disease is classified into two types: if the cerebrospinal fluid pathways are free, but the outflow of fluid is reduced - open form, if the channels are closed - occlusive or closed.

Based on the time of development and clinical signs, the disease is divided into three types:

• Acute stage. Characterized by a rapid increase in intracranial pressure, sharp deterioration the patient’s condition (for three or less days).
• Subacute stage. Develops over the course of a month. Characterized by a gradual deterioration in the condition of the newborn, often leading to severe lesions brain
• Chronic dropsy. Intracranial pressure increases gradually - over 3-6 months or more.

Causes of water in a child’s head

Hydrocephalus in newborns is often a congenital pathology. In three out of four cases, the cause is infectious disease central nervous system, developed in utero. Every third newborn suffers from dropsy due to a head injury during childbirth. In children of different age categories, the causes of the development of the disease may differ:

Infections, defects, anomalies and oncological formations

Dropsy can be caused by a huge number of reasons. It is noteworthy that some of them may be common to all patients, while others occur only in certain age category. TO infectious causes include:

• rubella;
• cytomegalovirus infection provoked by herpes virus type 1 or 2;
• toxoplasmosis;
• pig or parotitis;
• meningitis and meningoencephalitis, provoked by bacteria and viruses: Haemophilus influenzae, pneumococcus, herpes viruses, meningococcus.

Hydrocephalus in a child of tumor origin is provoked by papillomas, carcinomas, tumors of the cerebral ventricles or skull bones, oncological diseases of the spinal cord, cancer with metastases to the brain. Among the defects leading to the development of dropsy are:

• Dandy-Walker syndrome is a pathology of the development of the cerebellum and subarachnoid spaces. It is characterized by excessive expansion of the fourth ventricle of the posterior cranial fossa and underdevelopment of the middle lobe of the cerebellar vermis.
• Arnold-Chiari syndrome is an anomaly in which the contents of the posterior fossa of the skull descend into foramen magnum.
• Arachnoid cysts, congenital or acquired after meningitis, surgery, Marfan syndrome.
• Narrowing of the cerebrospinal fluid channels of the brain.
• Congenital underdevelopment of the cerebral veins or openings through which cerebrospinal fluid flows from the aqueduct into the subarachnoid space.

Risk factors for hydrocephalus

Doctors identify provoking factors as a separate group, which significantly increase the risk of developing dropsy and lead to disturbances in the development and maturation of the nervous system:

• use of active obstetric aids during childbirth - vacuum, forceps;
• hypoxia or asphyxia of the fetus;
• prematurity, premature birth before 35 weeks;
• the baby's weight is less than one and a half kilograms;
• pulmonary hypertension in a newborn;
• mother's narrow pelvis;
• intrauterine diseases affecting the internal organs of the fetus;
• Availability bad habits from the mother, from which she did not get rid of before conception;
• infections suffered by a pregnant woman - ARVI, herpes, toxoplasmosis, mononucleosis.

Signs of hydrocephalus in children

Clinical symptoms of pathology may begin to appear from the first days of life or arise gradually. The intensity of development of hydrocephalus depends on the severity, presence intracranial hypertension and forms of the disease. Severe forms of dropsy are often associated with irreversible disorders of the central nervous system and lead to the death of the infant in the neonatal period. Early signs illness: hyperactivity, tearfulness, excessive regurgitation, anxiety.

With the rapid progression of hydrocephalus, convulsions and drowsiness appear. The child may lose skills acquired during development: sitting, speaking, fine motor skills. Sometimes complete or partial paralysis of the limbs develops. It helps to identify hydrocephalus by external signs big head with a relatively small body, overhanging forehead, exophthalmos (displacement of the eyeballs forward), strabismus. Signs may vary slightly depending on age.

In children under 2 years of age

At this age, symptoms of congenital hydrocephalus appear. The disease occurs with complications - serious deviations in the development of brain structures and the central nervous system develop, and the baby’s condition quickly deteriorates. This is due to the fact that the bones of the skull are not yet tightly fused and can shift, forming additional space for the accumulation of cerebrospinal fluid. In this regard, the main symptom of dropsy is considered to be a progressive enlargement of the head (more than 1.5 cm per month). Other signs:

• manifestation on the frontal, temporal or occipital lobe the head veins are blue-green;
• insufficient weight gain in newborns;
• tearfulness, irritability, poor sleep;
• the baby does not know how to smile, begins to hold his head independently after three months;
• an increase in the size of the frontal lobe of the head, the brow ridges hang over the eyes;
• drooping eyelids;
• the child begins to sit, crawl, and walk late;
• the skin on the head is shiny, and the fontanel protrudes above the main part of the skull and pulsates under the fingers;
• the presence of divergent strabismus, moving pupils when trying to fixate the gaze - the eyeball will oscillate up/down or right/left (nystagmus);
• the baby is capricious, sucks breast milk sluggishly, and often spits up;
• It is difficult for a newborn to straighten his knees.

Over 2 years old

When the sutures of the skull have already fused, there is no fontanelle, the size of the skull will not increase, and excess cerebrospinal fluid will increase intracranial pressure and cause damage to brain structures. The main symptoms of hydrocephalus in children over two years of age:

• frequent headaches that worsen with mental stress, stress, or after sleep;
• nosebleeds;
• nausea with vomiting due to increased migraines;
• painful sensations behind the eyeballs;
• insomnia;
• decreased visual acuity, double vision;
• poor coordination;
• retardation in mental and physical development;
• chin tremor;
• urinary incontinence;
• psychomotor agitation;
• causeless weight gain, obesity;
• attention deficit;
• decreased muscle tone;
• walking on tiptoes;
• cyanosis under the eyes, visible when stretching the eyelid blood vessels.

Diagnostics

A preliminary diagnosis can be made by a neonatologist during a visual examination of the newborn. The reason for contacting a pediatric neurologist, pediatrician or neurosurgeon is that the size of the cranium is larger than age norm. The doctor must carefully examine the medical history and external signs of the disease. To confirm the diagnosis of hydrocephalic syndrome, screening tests are performed:

• Neurosonography (ultrasound of the skull through the fontanel) is a two-dimensional method for studying the structures of the brain through an open large fontanel. The method helps to identify congenital abnormalities of the central nervous system, measure the size of the ventricles, and examine in more detail different structures of the brain. Screening is carried out only for infants in the first months of life.
• CT ( CT scan) – study of the structure of gray matter by constructing an image of the contents of the cranium on a computer monitor screen. CT can detect developmental anomalies, tumors, foci of inflammation, and post-traumatic changes. CT replaces skull radiography.
• MRI of the brain (magnetic resonance imaging) is a layer-by-layer scanning method of the brain used to identify abnormalities, the presence of hemorrhages, tumors, and cysts. The resulting image helps the neurologist judge the structure of the blood vessels.

Children with diagnosed hydrocephalus need to consult an ophthalmologist or pediatric ophthalmologist, to determine initial signs atrophy of the optic nerves. For this purpose, ophthalmoscopy is prescribed - visual inspection eye and assessing the transparency of the sclera using a special apparatus. If necessary, additional neurological diagnostics assigned:

• echoencephalography – ultrasound diagnostics that helps assess the level of intracranial pressure and identify the presence of space-occupying formations;
• EEG (electroencephalography) is a method of recording bioelectric signals from brain cells. An EEG is necessary to measure brain activity.
• MR angiography is a hardware technique that helps visualize venous sinuses, drains, the nature of blood flow in brain tissue.

Treatment of hydrocephalus in a child

Dropsy of the brain is a serious disease that requires immediate and comprehensive treatment. When a pathology is detected on initial stage To compensate for the outflow of cerebrospinal fluid, small patients are prescribed diuretics, saluretics or carbonic anhydrase inhibitors. If the chosen technique does not bring results, surgical intervention is resorted to. After the operation it is prescribed physical therapy and diet. Cure from hydrocephalus folk remedies impossible.

Drug therapy

To reduce intracranial pressure, improve and at the same time accelerate the removal of cerebrospinal fluid, diuretics and potassium supplements are prescribed. For non-progressive open hydrocephalus, treatment is possible in outpatient setting. The doctor prescribes:

• Diacarb. Active substance– acetazolamide. A medicine with a weak diuretic effect blocks the enzyme responsible for the production of cerebrospinal fluid. Diacarb helps relieve swelling, stop an acute attack of glaucoma, and reduces intracranial pressure. The drug is available in tablets, therefore it is prescribed only to children over three years of age in the age dosage given in the instructions. Diacarb can cause numerous adverse reactions and is contraindicated in uremia, acute hepatic or renal failure.
• Asparkam. The active ingredient is magnesium and potassium aspartate. The drug promotes recovery electrolyte balance, supports normal cardiac activity. Asparkam is prescribed together with Diacarb to compensate for the potassium-removing effect of the latter. The course of treatment and dosage is selected individually. The medicine may cause nausea, vomiting, and dizziness. Asparkam is contraindicated in cases of renal dysfunction, hemolysis, acidosis, and dehydration. In case of individual intolerance, the tablets are replaced with Panangin.

With a significant increase in intracranial pressure, conservative treatment is carried out only in a hospital setting. Medicines are prescribed to help remove fluid from the space of the cranium. Two groups of diuretics are used:

• Osmotic - drugs provoke an increase in the level of osmolar plasma, which promotes the removal of excess fluid from the body by the kidneys. Medicines are used only after laboratory research plasma osmolar level. Medicines have multiple side effects, therefore they are used according to strict doctor’s instructions. Osmotic diuretics include: Mannitol.
• Saline - removes excess liquid by blocking the absorption of sodium and chlorine ions in the kidneys. Products in this category are used in conjunction with potassium preparations. Saline diuretics include: Furosemide, Lasix.

Surgery

With progressive hydrocephalus in children, if drug treatment did not bring results 2-3 months after the start, surgical intervention is necessary. At open form For diseases, doctors perform lumbar or ventricular puncture, external drainage - operations that help temporarily reduce the level of intracranial pressure. For closed forms of dropsy, the following is prescribed:

• clipping, coagulation of the choroid plexus - operations that help suppress the synthesis of cerebrospinal fluid;
• excision of tumors, hematomas, ventriculostomy - methods of surgical intervention in the cranial cavity aimed at restoring natural fluid circulation or creating new pathways for the outflow of secretions;
• shunting is an operation to establish the outflow of fluid to other functional systems of the body.

Prognosis and prevention of hydrocephalus in a child

Timely diagnosis problems and treatment initiated increase the child’s chances of life and further normal development. The effectiveness of treatment may depend on the form of the disease, the causes of its occurrence and individual characteristics body. The acquired disease has worst prognosis than congenital dropsy. Even if the syndrome is completely curable, complications often develop:

• hydroencephalopathy;
• chronic migraine;
• epileptic seizures;
• complete loss of vision or hearing;
• speech disorder;
• weakness in the muscles of the arms or legs;
• disorders of the cardiovascular or respiratory system;
• urinary incontinence;
• the head circumference remains increased in relation to other parts of the body.

To reduce the chances of dropsy occurring, you must follow the following rules of prevention:

• Protect your child from falls and head injuries. Wear a helmet when riding a bicycle, skating, or rollerblading. Transport your baby in a car only if it is fastened in a special child seat.
• When planning a pregnancy, give up bad habits and undergo all necessary screening tests.
• If you become infected with infectious diseases during pregnancy, do an additional ultrasound of the fetus, donate blood for analysis, and consult an infectious disease specialist about further management of the pregnancy.
• If a child was born premature or was injured during childbirth, undergo regular routine examinations with a pediatrician, neurologist, or ophthalmologist. If necessary, perform ultrasound, CT, MRI.
• Do not treat meningitis and meningoencephalitis with disdain. Treat pathologies promptly and completely.

Video

The disease known as cerebral hydrocephalus in children is one of the most dangerous and rapidly progressing, so knowledge about it can save the life of a child.

The name of the disease includes two words: “hydro” (water) and “cephalon” (head), and is often colloquially referred to as “dropsy of the brain.”

It is known that in the brain of Homosapiens there are several so-called ventricles, connected in series and filled with cerebrospinal fluid.

Liquor is a specific cerebrospinal fluid that has a significant visual resemblance to water (which is reflected in the colloquial name of the disease).

This fluid is continuously produced in the lateral ventricles (I and II) and flows along the route “I and II ventricles - III ventricle of the brain - IV ventricle of the brain - subarachnoid space (otherwise - subarachnoid space, located between the hard membranes of the brain and the brain itself) and then - washes the brain itself, specifically the outer surface, then being absorbed into the blood.

It is disturbances in the flow, production or absorption of cerebrospinal fluid that provoke its accumulation in any part of the brain diagnosed by doctors.

Many classifications of hydrocephalus have been developed, of which the most commonly used are the following:

1. depending on the pathways of cerebrospinal fluid circulation- occlusive (otherwise - non-communicating, closed) hydrocephalus, characterized by the fact that the cerebrospinal fluid does not enter the subarachnoid space due to any obstacles along the way (without outflow), and communicating (otherwise - open) hydrocephalus, characterized by the fact that there are problems with there is no outflow of cerebrospinal fluid;
2. depending on genesis- primary hydrocephalus, which is the main disease of the child, and secondary, accompanying another disease (complication, for example, with brain tumors, with lesions of the central nervous system, other ailments);
3. depending on the degree of occurrence- congenital (due to abnormalities during intrauterine development), as well as acquired hydrocephalus (developed in initially healthy babies);
4. depending on the location of the cerebrospinal fluid accumulation- external (CSF accumulates around the skull, this is visualized as a large head), internal (CSF accumulates inside the ventricles, visually not noticeable) and mixed hydrocephalus.

Hydrocephalus of the brain in children: symptoms

Among the main symptoms of hydrocephalus there are those that are noticeable only to a specialist.

And there are symptoms that parents themselves can track by regularly examining their baby:

• an excessive increase in the circumference of an infant’s head is the main symptom for children under two years of age; this symptom is also visible to parents, who can themselves (as well as a pediatrician at a monthly examination) measure the circumference of the baby’s head and compare it with the norm;
• the presence of a venous network on the baby’s face;
• a bulging, and at the same time enlarged, large fontanel - normally it closes by about one year, and with hydrocephalus it is open up to two and sometimes three years;
• disproportionate enlargement of the skull in the forehead area, as if protruding forward and upward;
• frequent vomiting and headache;
• irritability of the child, sometimes - unmotivated tearfulness and apathy;
• frequent muscle hypertonicity and trembling of the baby’s arms and legs;
• “dropping” of the eyeball, when a white membrane appears between the pupil and both eyelids;
• a lag in psychophysiological development, increasingly noticeable over time.

Advice to parents: if you notice at least one or two of the symptoms described above, contact a specialist (neurologist or neurosurgeon), even if your pediatrician does not give such recommendations. Perhaps, while constantly being with your child, you noticed something that the doctor might have missed at the appointment.

Causes of occurrence in children

Often, a child is diagnosed with increased ICP (), and such a diagnosis also implies the appearance of hydrocephalus in the baby, because the increase in ICP is precisely caused by difficulties with the outflow of cerebrospinal fluid.

If we talk about the reasons for the appearance and development of such disorders, then hydrocephalus of the brain in children under one year old will differ from the course of the disease in older children.

most often occurs due to the following reasons:

• malformations of intrauterine development of the fetal brain;
• consequences of infections suffered in the womb, such as cytomegaly, toxoplasmosis, etc.;
• fetal prematurity;
• (very rarely);
• birth trauma with intracerebral hemorrhage, and sometimes with meningitis.

For children aged 1 - 2 years and older:

• suffered by a child (inflammation of the membranes of the brain) and / or encephalitis (inflammation of the brain substance itself);
• suffered severe infectious diseases (for example, tuberculosis);
• brain tumors (not only the brain, but also the spinal cord);
• malformations of the child’s central nervous system or the entire vascular system of the brain;
• consequences of any head injuries suffered by the child;
• occurred cerebral hemorrhages.

Of course, individually, these reasons do not yet guarantee the appearance of hydrocephalus, but these are reasons to monitor the baby even more carefully to exclude it.

Open and outdoor shapes

Depending on the form of flow of the accumulating cerebrospinal fluid, the following are distinguished:

• open external form of the disease, characterized by impaired absorption of cerebrospinal fluid, but with the remaining free communication of the ventricles producing this fluid;
• closed external form of the disease, characterized by the fact that there is no free communication between the liquor-bearing cavities;
• external, characterized by a decrease in the volume of the gray matter of the brain due to its replacement with excess cerebrospinal fluid, and therefore this form is the most dangerous, because it can be almost asymptomatic for quite a long time.

Do not neglect examinations by a doctor (at first - every month, then less often), as well as checking the child with special diagnostic equipment, if necessary.

Consequences

In case of late diagnosis of the problem, untimely provision (or even failure to provide at all) of medical care to a child with hydrocephalus, the onset of any complications is inevitable.

Advanced hydrocephalus of the brain in children, the most common consequences are as follows::

• various speech disorders;
• constant severe headaches caused by a further increase (permanent) intracranial pressure in the child;
• development of visual impairment, up to the onset of blindness;
• a significant lag behind peers in physical and mental development;
• the appearance of epileptic seizures in a child.

In case of setting such terrible diagnosis You shouldn’t give up, because timely medical assistance can, if not completely cure the baby, then certainly stop the development of the disease.

Treatment

The primary diagnosis of hydrocephalus can be made by a pediatrician, neonatologist, or neurologist (neurologist).

However, such a diagnosis must be confirmed by a neurosurgeon after conducting a set of studies, including laboratory tests:

If the above methods, in particular CT and - especially - MRI, confirm the diagnosis of “hydrocephalus of the brain in children”, treatment should begin immediately.

MRI of a child's brain

The most commonly used type of treatment is surgical: the child undergoes surgery to install a system of silicone catheters, through which excess cerebrospinal fluid is drained from the sites of production (that is, from the lateral ventricles) into the peritoneum for absorption between the intestinal loops.

The volume of discharged liquid is regulated by built-in special valves. This operation is called “ventriculo-peritoneal shunt”. It is also important to know that these catheters are placed subcutaneously and are therefore not visible to anyone.

An operation has also been invented that makes it possible to do without installation into the body. foreign bodies(catheters) - endoscopic ventriculostomy. During this operation, a bypass path for the outflow of excess fluid is created deep in the child’s brain using an endoscope.

However, unfortunately, this type surgical care is effective only in cases of illness in children, some variants of closed hydrocephalus (and this is no more than ten percent of the total number of patients with such a diagnosis), in all other cases its effectiveness is insignificant, which means that implantation of a shunt system is necessary.

Tablets "Diacarb"

There are also variants of the disease in question in which surgical treatment not required. This often happens if there are no signs of progression of the disease and with normal intracranial pressure.

In this case, drug treatment is used: patients are prescribed the drug "Diacarb", which is the only active drug, which reduces the volume of cerebrospinal fluid production. In addition, the patient is under constant supervision of a specialist neurosurgeon/neurologist, who carefully monitors all changes in the patient’s condition.

Remember that regardless of your fear of surgery, you can save your child during surgery! Yes, your baby will have several catheters implanted, but he will live!

Video on the topic

Tips for parents with hydrocephalic syndrome in children:

Thank you

Hydrocephalus (dropsy brain) is a disease in which excess cerebral fluid accumulates in the cavities of the brain, called the ventricles. This disease can develop at any age, but the most common is congenital hydrocephalus, which manifests itself in infants during the first three months of life. The incidence of hydrocephalus is low - 1 case in 2000 - 4000 newborns, and the disease most often develops in boys. With hydrocephalus, enlarged ventricles compress the brain, which is manifested by various neurological disorders.

Essence and brief characteristics of the disease

Currently, the diagnosis is also very widespread hypertensive-hydrocephalic syndrome, which is diagnosed in 80–90% of children in the first year of life and is interpreted in the public consciousness as a combination of increased intracranial pressure with hydrocephalus. This diagnosis is an example of identifying a non-existent pathology based on deviations from the average norm that are normal for children in the first year of life. After identifying this non-existent disease, there follows the unreasonable prescription of diuretics, nootropics, drugs that improve cerebral circulation, etc., which are not needed by the baby, since if it develops normally, then all deviations in the neurosonogram and tonogram are variants of the norm. In fact, in world practice there is no diagnosis of “hypertension-hydrocephalic syndrome”, and, naturally, no one means by it a combination of increased intracranial pressure and hydrocephalus. When it comes to hydrocephalus, you either have it or you don’t, and this disease can only be treated surgically, since no conservative methods will not help cope with the problem of excess fluid in the skull.

In this article we will look at hydrocephalus, and not the mythical hypertensive-hydrocephalic syndrome.

So, returning to hydrocephalus, it must be said that the normal amount of cerebrospinal fluid is constant, and is about 50 ml in an infant and 120 - 150 ml in an adult. With hydrocephalus, the amount of cerebrospinal fluid present in the brain structures is significantly higher than normal, which leads to compression of the brain structures and the appearance of characteristic neurological symptoms.

To understand the essence of hydrocephalus, you need to clearly understand what cerebrospinal fluid is, how it is produced and where it is disposed of. Thus, normally, a certain amount of fluid is constantly produced in the brain, which is distributed in the ventricles, cisterns and subarachnoid fissures. This fluid constantly circulates, thereby maintaining an optimal environment for the functioning of the brain, removing metabolic products and delivering the chemical compounds they need to the cells. Also, the cerebrospinal fluid ensures a constant and stable location of the brain in the cranium, preventing it from moving and wedging into the opening of the skull into which it enters. spinal cord. In addition, cerebrospinal fluid (CSF) acts as a shock absorber, reducing the severity of brain damage from blows to the head.

Normally, part of the cerebral fluid produced by the choroid plexuses of the brain is resorbed (absorbed) into the systemic bloodstream in the occipital-parietal region, part remains in the cerebrospinal fluid spaces, and another part enters the spinal canal. Thanks to the continuous production, circulation and removal of a certain amount of cerebrospinal fluid into the bloodstream, the cerebrospinal fluid is constantly renewed, due to which toxic metabolic products, etc., do not accumulate in it.

If for some reason the cerebrospinal fluid is produced in too large a volume or only a small part of it is resorbed into the systemic bloodstream, then the cerebrospinal fluid accumulates in the cranium, causing an increase in the ventricles of the brain, cisterns and subarachnoid fissures (see Figure 1), which is hydrocephalus. That is, the leading mechanism in the development of hydrocephalus is the discrepancy between the volumes of produced and resorbed cerebrospinal fluid. The stronger the discrepancy, the more severe and pronounced the hydrocephalus and the faster complications develop, including irreversible brain damage.

Picture 1– Normal and enlarged ventricles of the brain due to hydrocephalus.

Hydrocephalus can develop at any age, but most often this disease is congenital. Congenital hydrocephalus, as a rule, is caused by infectious diseases suffered by a woman during pregnancy (cytomegalovirus infection, toxoplasmosis, etc.), prolonged and severe fetal hypoxia, tumors or malformations of the central nervous system in the newborn baby. Acquired hydrocephalus, as a rule, develops as a result of diseases of the central nervous system (meningitis, encephalitis, etc.), traumatic injuries to the head, severe intoxication (for example, after poisoning or severe infectious diseases, etc.), as well as in the presence of tumors in the brain brain.

Clinical manifestations of hydrocephalus are a combination of external changes in the skull and various neurological disorders caused by compression and atrophy of the brain.

A sign of hydrocephalus that is clearly visible to the naked eye is a progressive increase in head circumference. Moreover, what is characteristic is a progressive increase in the size of the head, and not a constant but large circumference. That is, if a person has a larger skull circumference than normal, but it does not increase over time, then we are not talking about hydrocephalus. But if the size of the skull constantly and steadily increases over time, then this is a sign of hydrocephalus.

Besides, in infants under 2 years of age external signs hydrocephalus can be the following:

• Protruding and tense fontanelles;
• Round pulsating protrusions between the bones of the skull that are not completely fused;
• Frequent tilting of the head;
• Disproportional big forehead with strongly overhanging brow ridges.

• Strabismus divergent;
• Nystagmus (oscillations of the eyeballs when they are abducted to the left, right, up and down);
• The “setting sun” symptom (when the eyes move, the eyeball periodically moves down and inward, resulting in a wide strip of sclera);
• Weakness of the muscles of the arms and legs in combination with hypertonicity;
• Deterioration of vision, hearing;

To diagnose hydrocephalus, head circumference is measured, a brain tomogram and dynamic neurosonography are performed. That is, if the results of 2–3 measurements, tomograms or neurosonograms carried out over 2–3 months reveal progressive changes, then we are talking about hydrocephalus. For example, if the results of tomograms or neurosonograms indicate an increase in the size of the ventricles and a simultaneous decrease in brain volume, then this is a sign of hydrocephalus. A single detection of a slight increase in the size of the cerebrospinal fluid system of the brain and head circumference does not have diagnostic value and may not indicate hydrocephalus.

The only treatment for hydrocephalus is surgical shunting to remove excess fluid from the cranial cavity and normalize its movement through the structures of the brain. Taking diuretics (Diacarb, etc.) is possible only as a temporary measure in preparation for surgery in order to reduce the rate of progression of hydrocephalus.

Hydrocephalus – photo

This photograph shows a child suffering from hydrocephalus with a disproportionately large forehead and strabismus.

Types of hydrocephalus (classification)

Yes, depending on the character causative factor and the mechanism of development, there are two types of hydrocephalus:

• Closed hydrocephalus (non-communicating, occlusive, obstructive);
• Open hydrocephalus (communicating).

Closed hydrocephalus

The causes of impaired fluid outflow with closed hydrocephalus can be a narrowing of the brain aqueduct, tumors, cysts, hemorrhages, closure of the foramina of Magendie and Luschka.

Depending on what part of the liquor system the obstacle is located in, expansion and increase in volume of only certain structures occurs. For example, when one foramen of Monroe is closed, hydrocephalus of one lateral ventricle of the brain develops; when both foramina of Monroe are blocked, hydrocephalus of both lateral ventricles develops; when the aqueduct is narrowed, hydrocephalus of the lateral and third ventricles develops; when the foramina of Magendie and Luschka are blocked, hydrocephalus of all structures of the cerebrospinal fluid system occurs.

With closed hydrocephalus, intracranial pressure increases, which leads to an enlargement of the ventricles of the brain, which can pinch and compress the brain structures, leading to the appearance of neurological symptoms.

Open hydrocephalus

Due to this malabsorption, the balance between the production and resorption of cerebrospinal fluid is established only by increasing intracranial pressure. Against the background of constantly increased intracranial pressure, expansion of the ventricles and subarachnoid spaces of the brain occurs with gradual atrophy of the medulla.

The causes of open hydrocephalus are usually inflammatory processes in the meninges, such as meningitis, cysticercosis, sarcoidosis, hemorrhages or metastases. It is extremely rare that the cause of open hydrocephalus can be a tumor of the choroid plexus of the brain that produces too much cerebrospinal fluid.

Reasons replacement hydrocephalus are various states and diseases leading to brain atrophy, such as:

• Age-related changes in brain tissue;
• Vascular encephalopathy (brain atrophy due to circulatory disorders in its structures, for example, with atherosclerosis of cerebral vessels, hypertension, diabetic angiopathy, etc.);
• Toxic encephalopathy (brain atrophy due to poisoning by various substances);
• Creutzfeldt-Jakob disease.

• Acute hydrocephalus;
• Chronic hydrocephalus.

Acute hydrocephalus

Chronic hydrocephalus

Depending on the location of excess fluid in the structures of the skull, hydrocephalus is divided into the following types:

• External hydrocephalus.
• Internal hydrocephalus.

External hydrocephalus

Internal hydrocephalus

Mixed hydrocephalus

Depending on the severity of brain structure disorders resulting from hydrocephalus, the disease is divided into the following types:

• Compensated hydrocephalus (excess fluid is present, but does not compress the brain structures, as a result of which the person has no symptoms of the disease, general state normal and development is not impaired).
• Decompensated hydrocephalus (excess fluid leads to compression of the brain, resulting in the development of neurological symptoms and severe disorders of higher nervous activity and development).

Moderate and severe hydrocephalus

However, such changes in MRI images only indicate that at the current moment in time a person has some change in the volume of the structures of the cerebrospinal fluid system of the brain, which is in no way a sign of hydrocephalus. It’s just that at the current moment in time, the person who applied for diagnostics has non-ideal shapes and sizes of brain structures. Such changes can form and disappear without a trace many times throughout life, without causing harm to a person, without manifesting characteristic neurological symptoms and without requiring special treatment. Therefore, it is impossible to make a diagnosis of “moderate hydrocephalus” or “severe hydrocephalus” based on a single MRI examination.

After all, hydrocephalus is manifested by a progressive increase in the volume of fluid in the structures of the brain, therefore, in order for the diagnosis of this severe pathology to be made correctly and correctly, without exaggeration, it is necessary to conduct an MRI study 2 - 3 times at intervals of 2 - 3 weeks. If the results of each subsequent MRI indicate that the volume of fluid in the brain has increased compared to the time of the last examination, then this is the basis for making a diagnosis of hydrocephalus. And a single detection of slightly enlarged ventricles and other structures of the cerebrospinal fluid system does not provide grounds for a diagnosis of hydrocephalus. But experts describing the MRI result indicate in their conclusion “moderate hydrocephalus” if the changes in brain structures are completely insignificant, and “severe hydrocephalus” if there are somewhat more of them, but still within the limits of normal fluctuations. Further, this description of an MRI diagnostic specialist is rewritten by therapists and neurologists, becoming a diagnosis with which a person lives.

This practice does not seem entirely correct, since in all such cases we are not talking about hydrocephalus as a disease, but about changes in the volume of the cerebrospinal fluid structures of the brain that have arisen for some reason. In such cases, it seems advisable to find out the reasons for the changes that have occurred and prescribe appropriate therapy. And people who have been diagnosed with “moderate hydrocephalus” or “severe hydrocephalus” need to remember that this disease is very serious, and if they really had it, then within 6 to 12 months without surgery it would cause constant progressive deterioration of the condition, and would ultimately lead to death.

Causes of hydrocephalus

In older children (over 12 years old) and adults, the leading symptoms of hydrocephalus are signs of increased intracranial pressure. As the symptoms of increased cranial pressure progress and become more severe, they are accompanied by neurological disorders caused by infringement of brain structures. The first neurological disorders in hydrocephalus to develop are visual and vestibular disorders. Then they are joined by disorders of complexly coordinated voluntary movements and various types sensitivity (pain, tactile, etc.).

So, the symptoms of hydrocephalus in adults include the following manifestations:

1. Symptoms caused by increased intracranial pressure:

• A feeling of heaviness in the head that appears in the morning or after midnight;
• Headaches, most often developing in the morning or in the second half of the night, felt throughout the head without a specific localization;
• Increased headaches or a feeling of heaviness in the head when lying down;
• Nausea or vomiting in the morning, not associated with eating or drinking;
• Feeling of pressure on the eyes;
• Persistent hiccups;
• Sharp weakness, fatigue and constant fatigue;
• Drowsiness and persistent yawning;
• Inability to concentrate and perform even fairly simple actions;
• Apathy and "dullness";
• Nervousness;
• Changes in blood pressure;
• Tachycardia (heart rate more than 70 beats per minute) or bradycardia (heart rate less than 50 beats per minute);
• Dark circles under the eyes, when the skin stretches, numerous dilated capillaries are visible;
• Presyncope.

• Blurred vision (double vision, lack of focus);
• Decreased visual acuity;
• Loss of visual fields;
• Congestive swelling of the optic discs;
• Atrophy optic nerve with the development of complete blindness (observed only with long-term hydrocephalus);
• Strabismus;
• Dilation of the pupils of the eye with lack of reaction to light;
• Vestibular ataxia (a combination of dizziness, unsteady gait, tinnitus and head noise, and nystagmus);
• Paresis and paralysis of the limbs;
• Increased reflexes and muscle tone;
• Decreased or complete absence of all types of sensitivity (for example, a person may stop feeling touch, and the pain sensitivity threshold will increase significantly, etc.);
• Spastic contractures of the limbs (freezing of the arms or legs in a bent position with the inability to straighten them due to increased tone muscles);
• Cerebellar ataxia (a combination of impaired coordination of movements and gait, all movements are sweeping, poor handwriting) - occurs only with closed hydrocephalus with impaired movement of cerebrospinal fluid in the posterior cranial fossa;
• Emotional instability;
• Euphoria without visible reasons, turning into apathy;
• Aggressive behavior (occurs with a sharp increase in intracranial pressure).

Hydrocephalus in children under 2 years of age

Symptoms of hydrocephalus in children under 2 years of age include the following:

• The increase in head circumference is greater than normal (more than 1.5 cm per month) for 2 to 3 months in a row;
• Thinned bones of the skull and skin on the head (the skin is thin and shiny, veins are clearly visible through it);
• Open sutures of the skull and pulsating protrusions in them;
• Disproportionally large forehead with overhanging brow ridges;
• Tense and bulging fontanel;
• “Cracked pot” symptom (when you tap the skull with your knuckles, a sound like a cracked pot appears);
• Stagnant and dilated veins in the scalp area;
• Exotropia;
• Graefe's sign (a white stripe between the eyelid and the pupil that appears when the eye moves downward or blinks);
• Papilledema;
• Ptosis (drooping eyelids);
• Symptom of the “setting sun” (the child’s eyes are constantly lowered downwards, and a wide part of the sclera is visible from above);
• Paresis of the abducens nerves;
• Optic nerve atrophy;
• Deterioration of vision and hearing;
• Lack of reaction of the dilated pupil to light;
• Muscle hypertonicity;
• Frequent tilting of the head;
• irritability, restlessness, or drowsiness;
• Decreased appetite (the child eats little, is reluctant, and burps profusely after feeding);
• Slow psychomotor development (children begin to hold their heads up, roll over, walk, talk, etc. late);
• Loss of already developed skills;
• Reduced activity of the child;
• Vomiting, drowsiness, anxiety, convulsions (appear with the rapid progression of hydrocephalus even earlier than all the other above-mentioned symptoms).

Hydrocephalus in children over 2 years of age

• The child is lethargic, inactive, exhausted, apathetic, drowsy, as if “stunned”;
• Congestive and swollen optic discs;
• Persistent and progressive deterioration of vision and hearing up to complete blindness due to optic nerve atrophy;
• Double vision and difficulty focusing on a specific point;
• Strabismus;
• Headache in the morning, subsiding in the evening, but worsening when lying down;
• Pressing pain behind the eyes;
• Vomiting in the morning, unrelated to food intake or at the height of the severity of the headache;
• Adynamia;
• Irritability;
• Retarded physical and intellectual development;
• Hypothyroidism (low hormone levels thyroid gland in blood);
• Diabetes insipidus;
• Spastic paraparesis of the lower extremities;
• Hyperkinesis (involuntary uncontrollable sudden episodic twitching movements various parts body, such as tics of the arms, legs and face);
• Ataxia (impaired coordination of movements and gait);
• Bluish circles under the eyes, in the area of ​​which blood vessels are visible when the skin is stretched;
• Convulsions or breathing problems (usually recorded with open hydrocephalus).

Hydrocephalus in a child

As a rule, the main signs by which healthy children are currently diagnosed with “hydrocephalus” are dilatation of the ventricles of the brain, thickening of the interventricular septum, “cysts”, as well as an apparent “large” head and any that the neurologist does not like, identified by MRI or NSG results. or to parents, peculiarities of the child’s behavior (for example, regurgitation, crying, nervousness, reluctance to straighten legs, twitching of the chin, etc.).

In fact, a stable expansion of the cerebrospinal fluid structures of the brain (ventricles, cisterns, etc.) in children of the first year of life is a normal variant, does not require treatment and goes away on its own. If an MRI or NSG reveals an increase in the brain's cerebrospinal fluid structures in a baby, but it develops according to age, and on repeated MRIs and NSG, done 4 to 6 weeks later, the size of the cerebral ventricles and cisterns has not changed, then we are not talking about hydrocephalus, but about this age variant of the norm. Hydrocephalus can be suspected only if repeated MRI and NSG revealed a significant increase in the size of the cerebrospinal fluid structures of the brain.

A child’s subjectively seemingly large head is also not a sign of hydrocephalus, since the course of the disease is characterized by a constant increase in head circumference greater than normal. That is, if the child’s head is simply large, but its monthly increase is within the normal range (no more than 1.5 cm during the first three months and no more than 9 mm from 3 to 12 months), then this is not hydrocephalus, but a constitutional feature baby. Hydrocephalus can only be suspected if the child’s head grows by more than 1.5 cm every month.

The presence of single cysts in the brain of children in the first year of life is also an age norm. Such cysts do not pose a danger, do not have a negative effect on the subsequent neuropsychic development of the child and resolve on their own by 8–12 months.

And the numerous “symptoms” that parents and child neurologists attribute to signs of hydrocephalus do not stand up to criticism at all. After all, irritability, tearfulness, poor appetite, a shaky chin, squint, lethargy, muscle hypertonicity and other similar “symptoms” are not at all signs of hydrocephalus in the absence of a constant increase in head size beyond normal. All these characteristics of a child can be caused by a variety of factors, from heredity to the presence of any other diseases, but not hydrocephalus.

Therefore, parents whose child has been diagnosed with “hydrocephalus” or “hypertensive-hydrocephalic syndrome” should not be afraid and start treating the child with potent and dangerous diuretics in combination with nootropics. They are advised to get together and observe the child for 2 - 3 months, measuring the circumference of his head with a centimeter every 4 weeks. It is also recommended to do an MRI or NSG 2–3 times every 4–5 weeks. If the increase in the child’s head circumference is less than 1.5 cm per month, and on repeated NSG and MRI the size of the ventricles, cysts, cisterns and other brain structures has not increased, then the baby definitely does not have hydrocephalus. And only if the increase in head circumference is more than 1.5 cm per month, and repeated MRI and NSG show a noticeable increase in the ventricles and cisterns of the brain, can we talk about hydrocephalus.

Diagnostics

Currently, the following instrumental research methods are used to confirm and identify the cause of hydrocephalus:

• Head circumference measurement a centimeter tape (if a child’s head increases by more than 1.5 cm per month, this indicates hydrocephalus; an increase in the size of an adult’s head by any value indicates hydrocephalus).
• Fundus examination ophthalmologist. If the optic discs are swollen, this indicates increased intracranial pressure, which may be a sign of hydrocephalus.
• Ultrasound skull (neurosonography - NSG). The method is used only in children of the first year of life, in whom the brain can be examined through an open fontanel. Since in children over one year old and adults the fontanel is overgrown and the skull bones are too dense, the NSG method is not suitable for them. This method is very approximate and imprecise, so its results can be considered the basis for an MRI, and not for making a diagnosis of hydrocephalus.
• Magnetic resonance imaging (MRI)– is the “gold standard” in the diagnosis of hydrocephalus. The method allows not only to diagnose hydrocephalus, but also to identify its causes and existing damage in the structure of brain tissue. The criteria for hydrocephalus according to MRI results are an interventricular index of more than 0.5 and periventricular edema.
• Computed tomography (CT) is a method similar to MRI, but much less accurate and therefore used relatively rarely.
• Echoencephalography (EEG) and rheoencephalography (REG)– low-informative methods, which, nevertheless, are used for the “diagnosis” of hydrocephalus. results REG studies and the EEG can be completely ignored when deciding whether a person has hydrocephalus or not.

False diagnosis of hydrocephalus based on MRI, peripheral polyneuropathy, bursitis - video

Hydrocephalus - treatment

However, in rare cases, instead of surgery, hydrocephalus can be treated conservatively, with the help of diuretics, which remove excess fluid from the body and thereby prevent a constant increase in the volume of cerebrospinal fluid in the skull. Such conservative therapy can only be used for acquired hydrocephalus, for example, as a result of traumatic brain injury, after inflammatory disease or hemorrhages into the ventricles.

In all other cases, the treatment of hydrocephalus is only surgical, and diuretics can be used exclusively as a temporary, emergency measure, aimed at preventing the death of the patient while he is preparing for surgery. In all cases, for the conservative treatment of hydrocephalus, potent diuretics are used, such as Furosemide, Lasix, Diacarb, Fonurit or Mannitol.

Treatment of such a condition as “hypertensive-hydrocephalic syndrome” with the help of diuretics, from the position of neurosurgeons and leading specialists in the field of medicine, is nothing more than fiction. After all, hydrocephalus is either present or not, and if it is present, then this is an indication for urgent hospitalization and surgery, and not for long-term use of diuretics. Remember that taking diuretics will not cure existing hydrocephalus, but will only lead to the loss of precious time, which is necessary for prompt examination and surgical intervention. After all, the sooner the operation is performed, the fewer pathological changes there will be in the child’s brain.

So, returning to hydrocephalus, it must be said that the entire range of operations performed to treat this pathology is divided into two groups:

1. Operations with drainage of cerebrospinal fluid outside the central nervous system:

• Installation of a ventriculoperitoneal shunt (a shunt between the brain and the peritoneum);
• Installation of a ventriculoatrial shunt (between the brain and heart);
• Installation of a ventriculopleural shunt (between the brain and lungs);
• Installation of a ventriculourethral shunt (between the brain and the urethra);
• Installation of a ventriculovenous shunt (between the brain and veins).

• Torkildsen operation (ventriculocisternostomy). It consists of creating a communication between the lateral ventricle and the occipital cistern by installing a silicone catheter passed under the skin on the back of the head;
• Endoscopic ventriculostomy of the third ventricle. It consists of creating a communication between the third ventricle and the interpeduncular cistern by dissecting the bottom of the cistern in the area of ​​the gray tubercle;
• Implantation of internal stents. It consists of installing stents that expand the Magendie and Luschka holes to normal;
• Plastic surgery of the cerebral aqueduct. It consists of expanding the lumen of the water supply system to ensure normal circulation of cerebrospinal fluid;
• Fenestration of the interventricular septum. It consists of creating an opening between the ventricles through which cerebrospinal fluid can circulate freely.

Hydrocephalus: description, fluid balance in the brain, symptoms, surgical treatment, opinion of a neurosurgeon - video

When babies are born, most fathers and mothers are ready to take on the burden of responsibility for the life and health of the new generation. Unfortunately, the possibility cannot be ruled out that hydrocephalus of the brain in newborns will require even more effort from parents. Researchers have found that the disease is more likely to occur as a result of birth trauma, usually occurs in premature babies.

The medical term "hydrocephalus" corresponds to popular name brain diseases - dropsy. This word comes from the Greek “hydro” (water) and “cephalus” (head). The name reflects the characteristic feature - excessive accumulation of cerebrospinal fluid in the cavities of the brain(ventricles). The main causes of pathology should be sought in the characteristics of intrauterine development. The condition of a woman during pregnancy, the very moment of the birth of the baby, is of great importance.

The brain of a child in the neonatal period consists of several interconnected cavities filled with cerebrospinal fluid or cerebrospinal fluid. When the substance is produced or accumulated in excess, hydrocephalus develops in newborns, affecting the functions of the brain and the entire body. The pattern is not difficult to understand: the more cerebrospinal fluid is produced, the more difficult it is for the fluid to circulate, which makes the baby feel worse.

Thanks to ultrasound during pregnancy and prenatal diagnostics, pathologies of fetal development are detected in the period from 16 to 20 weeks from the moment the child is conceived.

About one in 500 babies is born with hydrocele. The main causes of hydrocephalus in newborns are considered to be intrauterine problems in the formation of the central nervous system. Triggers include some infections (herpes, cytomegalovirus, toxoplasmosis). The result is an imbalance between the volume of produced and circulating cerebrospinal fluid in the ventricles and under the meninges. Parents should pay attention to the appearance characteristic features this process, in particular an increase in head size and convulsions.

Symptoms of the disease

Hydrocephalus is considered congenital if pathological changes occur before birth. Acquired forms are caused by an unfavorable course labor activity in women, brain injuries in newborns. The sutures between the sections of the skull in infants have not yet matured, so the accumulation of fluid causes the bones to diverge. Signs of hydrocephalus in newborns are striking in that the volume of the head increases disproportionately, the fontanel protrudes, and many thin veins are noticeable under the skin.

Hydrocephalus in infants - symptoms:

• with external hydrocephalus in a newborn, the fontanel enlarges significantly and does not close in a timely manner;
• observed fast growth skull, resulting in a big difference between the circumferences of the head and body;
• the child does not hold his head up in due time (by about the 4th month);
• the baby is constantly lethargic, apathetic when time comes, is not interested in toys, does not respond to voices, does not smile;
• the baby cannot sit up on his own, crawl, and does not try to stand up (by 6–8 months);
• According to many signs, there is a lag in psychomotor development.

Infants suffering from hydrocephalus often cry, sometimes even with the usual touch of a palm to the head. One of the reasons for this condition is a severe headache. Hydrocephalus after two years is manifested by complaints of pain in the head. Malaise provokes an increase in intracranial pressure. If pathological changes increase, then examination of the fundus reveals swelling of the optic nerve.

Hydrocephalus is accompanied by nausea and uncontrollable vomiting at night and in the morning.

In addition, epileptic seizures occur and muscle hypertonicity develops. All of the above symptoms are characteristic not only of hydrocephalus. The same symptoms are caused by brain defects and various tumors. Parents should contact a neurologist or neurosurgeon regarding their illness.

Diagnostics

There are various examinations that help the doctor diagnose cerebral hydrocephalus in a newborn. However, even after discharge from the maternity hospital, parents and local pediatricians can ignore the symptoms, often little patient They make prescriptions for completely different diseases. If parents notice signs of hydrocephalus, they should insist on having the child examined by a neurologist. The baby’s chances of successful treatment decrease with each week of delay.

The variety of manifestations of hydrocephalus should be taken into account:

• enlarged ventricles, brain atrophy with normal intracranial pressure;
• impaired resorption of cerebrospinal fluid (this form and the next two are accompanied by an increase in intracranial pressure);
• increased formation of cerebrospinal fluid;
• deterioration of the outflow of cerebrospinal fluid.

At idiopathic hydrocephalus, intracranial pressure remains almost normal, but for an unknown reason the ventricles dilate brain

A number of studies are being conducted on children under two years of age, namely Ultrasound of the skull and brain, computed tomography and magnetic resonance imaging. Treatment of the disease in modern medical practice is considered difficult and expensive. The goal of any of the techniques used is to reduce or remove blockages on the path of cerebrospinal fluid from the cavities into the bloodstream. The prognosis and consequences of the disease depend on the severity of the symptoms of hydrocephalus.

Treatment of dropsy of the brain

The earlier therapy is started, the lower the risk of atrophic brain damage. One of the techniques is shunting - introducing thin tubes into the cavities of the brain and implanting them under the skin. Liquor is evacuated from the brain, cerebrospinal fluid is directed into the abdominal cavity or directly into the blood.

Small children grow quickly, this is one of the reasons for replacing drainage tubes more often with longer ones.

Silicone and plastic catheters are used for bypass surgery; a system of the required size can be individually assembled for each patient. Implanted shunts help remove cerebrospinal fluid to another part of the body. As a result, the volume of the brain cavities decreases, and the manifestations of hydrocephalus decrease.

Endoscopic ventriculostomy- a surgical operation that relieves cerebrospinal fluid pressure. The neurosurgeon makes a tiny hole in the wall of the brain ventricle using an endoscope. Thanks to this, excess cerebrospinal fluid drains and mixes with the rest of the cerebrospinal fluid. Such operations have already saved thousands of children around the world. It is especially important that after treatment the child gets rid of headaches and other symptoms. Children can lead a normal life, attend kindergarten and school, play, receive education and enjoy life.