CONCEPT : Ventricular dilatation , that is, an increase in the size of the cavities that contain cerebral cerebrospinal fluid (CSF) due to excessive accumulation due to disturbances in the production, circulation and reabsorption of cerebrospinal fluid secondary to multiple etiologies.
• It may be due to a problem in the normal reabsorption of the CSF or to an obstacle or obstruction in the normal flow of CSF at some point in the circuit between the ventricles and the cisterns of the base.
• The causes that cause hydrocephalus can be diverse and range from neonatal malformations, hematomas and brain hemorrhages, tumors and infections of the central or posttraumatic nervous system.
Hydrocephalus can be both infantile and affect adults. In case of neonatal hydrocephalus the patency of the sutures can sometimes allow that at the expense of a greater growth of the head ( megacephaly ), the neurological damage or vital risk secondary to hydrocephalus is not so obvious.
Regarding the speed of the establishment of hydrocephalus can be acute, subacute or chronic. The more acute the hydrocephalus, the greater the severity and vital risk, as well as the urgent need to be treated, since it is usually associated with different degrees of intracranial hypertension that can cause neurological damage.
Special mention for its frequency requires the so-called Adult Chronic Hydrocephalus or also known as normotensive Hydrocephalus (since unlike most hydrocephalus that occur with increased intracranial pressure, in these cases the pressure may be punctually normal, requiring several occasions for the correct diagnosis), which affects patients predominantly in the sixth and seventh decades of life and who has a symptomatology that resembles dementia, gait disorder, occasional incontinence of sphincters and different degrees of cognitive deterioration .
In view of the clinical suspicion of hydrocephalus or neurological deterioration, performing a CT or Magnetic Resonance will determine in most cases the diagnosis of hydrocephalus when the increase in ventricular size is observed, as well as the cause (malformation, tumor, hemorrhage ...). In neonates a transfontanel ultrasound (through fonatela that is only open in young children) can also establish the diagnosis. In patients with Chronic Adult Hydrocephalus , if the symptoms and imaging tests are inconclusive, as they are older people with different degrees of cerebral atrophy or vascular disease that can mimic the appearance of a hydrocephalus, more tests of the dynamics of the brain may be necessary. CSF, through CSF evacuation through a lumbar puncture (sometimes a drainage can be associated for several days) or by measuring the intracranial pressure in situations that would normally decompensate it (REM phase of sleep or infusing intrathecal serum).
Once the diagnosis of hydrocephalus has been made, the treatment can be endoscopic, especially in cases of obstructive hydrocephalus, causing the liquid that does not circulate through its natural conduit to do it through another path that we manufacture as a by-pass. In some cases, endoscopy may not be effective or in cases of hydrocephalus in which there is no obstruction, the therapeutic alternative consists of the ventriculo-peritoneal shunt in which excess CSF is evacuated through a catheter system that goes from the cavity cerebral ventricular to the abdomen whose pressure is regulated by an intercalated valve.