Hydrocephalus; definition, types, etiologies, investigations, management. Detailed review for medical students.

1. HYDROCEPHALUS
DR. FARRUKH JAVEED
CONSULTANT NEUROSURGEON
JPMC, KARACHI.

2. DEFINITION
• Greek-water in head
• Excessive accumulation
of CSF in the
ventricular system
secondary to increased
production or
decreased absorption

3. • Meninges suround the
brain & spinal cord and
are continuous
• Spinal arachnoid space
extends to S2

8. CSF VOLUMES
• 450 mL = CSF production
each day.
• CSF production is 0.3–0.37
mL/minute, 20 mL/h
• 150 mL = total volume
• 25 mL = within ventricles

9. CSF PRODUCTION
• a. 70% Choroid plexus
• b. 18% Ultrafiltrate
• c. 12% Metabolic H2O
produ

10. CHOROID PLEXUS
Primarily located in
• Roof of the fourth ventricle
• Inferior medullary velum
and lateral recess to the
foramen of Luschka
• Posterior roof of the third
ventricle
• Floors of the bodies and
roofs of the temporal horns
of the lateral ventricles

11. CSF VALUES

12. 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.

14. CLASSIFICATION
• Communicating (Non obstructive)
• Non Communicating (Obstructive)
‘BASED ON WHETHER THE VENTRICULAR SYSTEM
IS COMMUNICATING WITH THE SUB ARACHNOID
SPACE OR NOT’

15. 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
• Postinfectious

16. NON COMMUNICATING
CONGENITAL
• Aqueductal stenosis
• Congenital lesions (vein of
Galen malformation,
• congenital tumors)
• Arachnoid cyst
• Chiari malformations either
with or without
• myelomeningocele
• X-linked hydrocephalus
• Dandy-Walker malformation
ACQUIRED
• Aqueductal gliosis
(posthemorrhagic or
• postinfectious)
• Space-occupying lesions
such as tumors or cysts
• Head injuries

18. SIGNS AND SYMPTOMS
ADULTS
• Altered conciousness
• Lethargy
• Vomiting
• Seizures
• Sunsetting eyes
NPH TRIAD
• Dementia
• Gait ataxia
• Urinary incontinence
INFANTS
• Rapid head growth
• Tense fontanelle
• Distended scalp veins
• Decreased feeding
• Poor head control
• Splayed cranial sutures
• Sunsetting eyes
• Parinaud’s sign
• Frontal bossing

20. DIAGNOSIS
• X RAY
• ULTRASOUND
• CT BRAIN
• MRI BRAIN

21. X RAY
• SEPARATION OF SUTURES
• EROSION OF POSTERIOR
CLINOIDS
• INCREASED CONVOLUTIONAL
MARKINGS (gyral
impressions on the inner
table of the skull)SILVER
BEATEN APPEAREANCE

22. ULTRASOUND

23. COMPUTED TOMOGRAPHY

24. MRI
AQUEDUCTAL STENOSIS

25. PATHOLOGY VIA
IMAGING

26. NPH

27. CRANIOPHARYNGIOMA

28. INTRAVENTRICULAR PAPILLOMA

29. COLLOID CYST

30. PINEAL TUMOR

31. MEDULLOBLASTOMA

32. TUMOR ASSOCIATED

33. CP ANGLE

34. TBM

35. IV BLEED

36. ARNOLD CHIARI

37. DANDY WALKER
TRIAD
• POST FOSSA
CYST
• VERMIAN
AGENESIS
• HYDROCEPHALUS

38. TREATMENT
• MEDICAL
• SURGICAL

39. MEDICAL THERAPY
• No medical therapy that
definitively treats
hydrocephalus effectively.
• Acetazolamide (carbonic
anhydrase inhibitor)
• Furosemide,

40. SURGERY
TEMPORARY MEASURES
– Serial lumbar or ventricular punctures in very
small children
– EVD if infectious or hemorrhagic etiology
DEFINITIVE TREATMENT
– SHUNTS
– THIRD VENTRICULOSTOMY

41. SHUNT COMPONENTS

42. VENTRICULAR ACCESS ROUTES

44. LUMBO PERITONEAL SHUNT

45. 3rdVENTRICULOSTOMY

46. VIDEO

47. THANK YOU