HYDROCEPHALUS

Dr. Sana Akbar Qazi

Consultant Neurosurgeon
 DEFINITION
• Greek-water in head

• Excessive accumulation
of CSF in the
ventricular system
secondary to increased
production or
decreased absorption
• Meninges suround the
brain & spinal cord and
are continuous

• Spinal arachnoid space

extends to S2
 CSF PRODUCTION

• 70% Choroid plexus

• 18% Ultrafiltrate

• 12% Metabolic H2O

production
 CHOROID PLEXUS
Primarily located in

• Floors of the bodies and roofs

of the temporal horns of the
lateral ventricles
• Posterior roof of the third
ventricle
• Roof of the fourth ventricle
• Inferior medullary velum and
lateral recess to the foramen
of Luschka
 CSF VOLUMES
• CSF production each day:
450 ml

• CSF production is 0.3–

0.37 mL/minute, 20 mL/h

• total volume: 150 ml

• Ventricles: 25 ml
 FUNCTIONS
• Waste removal, carry nutrition to the brain,

• Cushioning of the brain

• Regulating various brain functions via

neurotransmitters, paracrine and endocrine effects.

• Hypothalamic hormones are secreted into the

cerebrospinal fluid (CSF) and transported by the
ependymal cells to the hypophyseal portal system.
CSF VALUES
CSF VALUES
PATHOLOGY
 CLASSIFICATION
• Communicating (Non obstructive)

• Non Communicating (Obstructive)

‘BASED ON WHETHER THE VENTRICULAR SYSTEM

IS COMMUNICATING WITH THE SUB ARACHNOID
SPACE OR NOT’
 COMMUNICATING
CONGENITAL
• Achondroplasia
• Associated with craniofacial syndromes

ACQUIRED
• Posthemorrhagic: intraventricular or subarachnoid
• Choroid plexus papilloma or choroid plexus carcinoma
• Venous obstruction as in superior vena cava syndrome
• Post-infectious
 NON COMMUNICATING
CONGENITAL ACQUIRED
• Aqueductal stenosis • Aqueductal gliosis
• Congenital lesions (vein of (posthemorrhagic or
Galen malformation, postinfectious)
congenital tumors) • Space-occupying lesions
• Arachnoid cyst such as tumors or cysts
• Chiari malformations either • Head injuries
with or without
myelomeningocele
• X-linked hydrocephalus
• Dandy-Walker malformation
 SIGNS AND SYMPTOMS
INFANTS ADULTS
• Rapid head growth • Altered conciousness
• Decreased feeding • Lethargy
• Vomiting
• Poor head control
• Seizures
• Tense fontanelle
• Distended scalp veins
NPH TRIAD
• Splayed cranial sutures • Dementia
• Sunsetting eyes • Gait ataxia
• Parinaud’s sign • Urinary incontinence
• Frontal bossing
 RADIOLOGY
• X RAY

• ULTRASOUND

• CT BRAIN

• MRI BRAIN
 X RAY
• Separation of sutures

• Erosion of posterior clinoid

• Increased Convolutional
Markings (gyral impressions
on the inner table of the
skull)\COPPER BEATEN
APPEAREANCE
ULTRASOUND
COMPUTED TOMOGRAPHY
MRI
PATHOLOGY VIA
IMAGING
 MRI

AQUEDUCTAL STENOSIS
NPH
CRANIOPHARYNGIOMA
INTRAVENTRICULAR PAPILLOMA
COLLOID CYST
PINEAL TUMOR
MEDULLOBLASTOMA
TUMOR ASSOCIATED
CP ANGLE
TBM
IV BLEED
ARNOLD CHIARI
DANDY WALKER

TRIAD
• POST FOSSA CYST
• VERMIAN AGENESIS
• HYDROCEPHALUS
 TREATMENT

• MEDICAL

• SURGICAL
 MEDICAL THERAPY
No medical therapy that
definitively treats
hydrocephalus effectively

• Acetazolamide (carbonic
anhydrase inhibitor)

• Furosemide
 SURGERY
TEMPORARY MEASURES
– Serial lumbar or ventricular punctures in very
small children
– EVD if infectious or hemorrhagic etiology

DEFINITIVE TREATMENT
– SHUNTS
– THIRD VENTRICULOSTOMY
SHUNT COMPONENTS
VENTRICULAR ACCESS ROUTES
Dandy’s Point
LUMBO PERITONEAL SHUNT
3rd VENTRICULOSTOMY
THANK YOU