Hydrocephaly in the young child
- I have a 4-year-old girl, who was born with hydrocephalus and lack of bald body. So far, the condition has not been evolutionary (at birth it had L = 50 cm and PC = 37 cm - and these 2 cm surpluses were kept constant), and the tomography did not indicate the need for surgery. But the last TC did it about 1 year ago, and ENCEPHABOL suspension did not take more than 6 months. From the motor point of view it has very easy balance problems, but its intellect is just above the average of its age. Is it possible that surgery is never needed? Could it in any way affect the lack of the bald body? I thank you from the heart and I expect from you a response and possibly advice, suggestions.Answer:
By definition, hydrocephalus is an accumulation of excess cerebrospinal fluid (LCS) inside the cerebral ventricles (internal hydrocephalus), epicerebral (external hydrocephalus) or in both natural liquid spaces.
In current practice the term hydrocephalus is addressed to internal hydrocephalus. It occurs when there is an imbalance between the secretion and absorption of the cerebrospinal fluid. Deficient absorption due to degrees of obstruction along the CSF circulation pathway is responsible for its accumulation in the ventricular cavities.
This pathological condition is encountered in many conditions, congenital or acquired, especially malformative but which, unfortunately, do not all benefit from an effective treatment.
Malformations of the CNS
A. Always with hydrocephalus
5. Multiple cystic encephalopathy
6. Malformations of the posterior fossa
a. Agenesis of vermis
b. Dandy-Walker syndrome
7. Agenesia of septum lucidum
B. Inconvenient with hydrocephalus
1. Cerebral hemispheres malformations
2. Arachnoid cysts
3. Malformations of the cerebral cortex
a. Megalencephaly and hemimegalencephaly
c. Frontal cortical dysplasia
e. Familial microcephaly
4. Agence of the callus body
b. Associated with other malformations of the CNS
The problem that is posed to the neurosurgeon when he is in front of a hydrocephalus is whether the patient's disease will improve or heal after a valve is placed. Viewed from this perspective, the contribution of imaging is essential in establishing the etiological diagnosis of certain congenital disorders that accompany hydrocephalus, especially since most of them, the term baby seems to have developed normally, except for the increased volume of the neurocranium. Depending on the etiology (cause) of hydrocephalus, the treatment to be decided will be decided.
Regarding your case it is very important to know what is the cause of hydrocephalus and if the lack of the body is accompanied by other malformations, but considering the positive evolution (lack of neurological disorders and stagnation of the surplus of the skull perimeter) it seems that it will not be necessary of a surgical treatment.
For a correct assessment of the condition of the little girl you must present with all the investigations to a specialist neuropsychiatrist, who after consultation and possibly new analyzes will explain to you depending on the results possible neurological and psychological evolution of your child.
Dr. Dana Paduraru,
Specialist in pediatric surgery
Emergency Clinic Hospital for Children "Grigore Alexandrescu"