Does hydrocephalus mean water in the brain?

Hydrocephalus refers to a state of excessive accumulation of cerebrospinal fluid in the ventricular system and/or subarachnoid space due to excessive secretion of cerebrospinal fluid, obstructed circulation or absorption disorders caused by various reasons, often accompanied by ventricular enlargement, corresponding reduction of brain parenchyma and increased intracranial pressure.

Therefore, hydrocephalus is not water in the brain, but an excess of cerebrospinal fluid. Cerebrospinal fluid is clear and transparent, similar to water, but its composition is similar to that of plasma and lymph.

1. What is cerebrospinal fluid? How much is the normal amount of cerebrospinal fluid in the human body?

Cerebrospinal fluid is a colorless transparent liquid that fills the ventricular system, the central canal of the spinal cord and the subarachnoid space. The total amount of cerebrospinal fluid in adults is about 150 ml, and about 500 ml of cerebrospinal fluid is secreted every day, so the cerebrospinal fluid needs to be replaced 3-4 times a day. Once the balance of the continuous production, circulation and absorption of cerebrospinal fluid is broken, excessive accumulation of cerebrospinal fluid in the skull will lead to hydrocephalus.

2. At what age does hydrocephalus occur most often?

The most common age groups for hydrocephalus are infants and young children (congenital hydrocephalus) and people over 60 years old (primary normal pressure hydrocephalus).

3. What causes hydrocephalus? What are the symptoms?

(1) Congenital factors: brain malformation, cerebral vascular malformation, spina bifida, etc. Case: An 11-month-old child, whose parents found that his fontanelle was full, the blood vessels on his face were bulging, his eyes were staring downward, his head was significantly larger than his face, and his overall development was significantly behind that of children of the same age. After going to the hospital for examination, he was diagnosed with hydrocephalus.

(2) Infectious factors: During infectious meningitis and encephalitis, the proliferating fibrous tissue blocks the circulation pathway of cerebrospinal fluid; the inflammatory response can also cause adhesion and occlusion of the brain cistern, subarachnoid space and arachnoid granules, leading to cerebrospinal fluid circulation and absorption disorders. Case: A 3-year-old male patient was hospitalized for viral encephalitis and was discharged after recovery. He vomited frequently six months later. His parents thought he had an upset stomach and repeatedly went to the gastroenterology department for consultation but there was no improvement. A head CT scan later revealed hydrocephalus.

(3) Intracranial hemorrhage and intracranial tumors caused by various reasons. Cerebral hemorrhage allows blood to enter the cerebrospinal fluid and block the cerebrospinal fluid circulation channel. During the growth of the tumor, the cerebrospinal fluid circulation channel is compressed and blocked. Case: A 68-year-old man was discharged from the hospital after conservative treatment for cerebral hemorrhage. Three months later, he developed dizziness, headache, decreased vision, weakness in the limbs, difficulty walking, and vomiting. He went to the hospital for a head CT scan and found hydrocephalus.

4. The harm of hydrocephalus

① It can lead to intellectual impairment. There may only be mild memory and calculation impairment, often accompanied by dullness, indifference, mutism, etc. In severe cases, it may lead to dementia.

② It will cause movement disorders. It is often difficult to start, and walking is slow and unstable.

③ Urinary and bowel disorders: Frequent urination, incontinence or difficulty in urination.

5. How to treat hydrocephalus?

(1) Drug treatment

The main purpose is to reduce the secretion of cerebrospinal fluid and increase the body's water excretion. Diuretics and dehydrating agents are commonly used, such as furosemide and mannitol. Drug therapy is a temporary treatment method to delay surgery. Long-term drug therapy for chronic hydrocephalus is ineffective and can easily cause water, electrolyte and acid-base imbalances.

(2) Surgical treatment

The preferred treatment for hydrocephalus. The choice of surgical method needs to be determined according to the specific situation of the patient.

① In principle, the cause of obstructive hydrocephalus should be identified first, and the cause of obstruction should be eliminated through surgery.

② If there is still obstruction after surgery, shunt surgery can be performed. The most common one is ventriculoperitoneal shunt. As shown in the following figure:

③For obstructive lesions that cannot be removed, shunt surgery can be performed directly.

④ Communicating hydrocephalus is often treated with shunt surgery. For example, for infantile communicating hydrocephalus, lumbar-peritoneal shunt surgery can be performed. Not only is the shunt tube short, but it is also horizontal, and the shunt effect will not be significantly affected by growth and development.

⑤ Some patients can undergo ventriculostomy of the third ventricle under ventriculoscopy (as shown below). By opening the bottom of the third ventricle, the cerebrospinal fluid in the ventricle can communicate with the subarachnoid space and restore the cerebrospinal fluid circulation.