Hydrocephalus, a matter of time

Written by: Dr. Ángel Horcajadas Almansa
Edited by: Top Doctors®

Hydrocephalus is a disorder of the cerebrospinal fluid that can have serious consequences of not being treated in a timely and adequate way. Cerebrospinal fluid (CSF) is found in the interior of the brain, in cavities called the ventricles and surrounding it, in the so-called subarachnoid space.


Cerebrospinal fluid

Hydrocephalus Up to now we produce about 500 ml of cerebrospinal fluid in the lateral ventricles, located on both sides of the midline of the brain. From there they pass to a third central ventricle through holes called Monro holes. From this, it passes into the fourth ventricle, located inside the cerebellum through a thin conduit called the Silvio aqueduct, and finally, from this ventricle, it circulates into the subarachnoid space from where it is reabsorbed and returned to the blood.

Any process that obstructs the free circulation of this liquid or hinders its reabsorption, causes an increase in the same in the brain called hydrocephalus (obstructive or resorptive respectively). Tumors located in the ventricles or in the vicinity of the narrower passageways cause obstructive hydrocephalus , as well as congenital narrowing of the Silvio aqueduct.


Symptoms of hydrocephalus

In Neurosurgery we understand different symptoms of hydrocephalus that vary according to the age of the patient and whether the CSF increase is fast (acute) or slow (chronic):

  • In infants who have not yet closed the bones of the skull, there is an increase in head size as well as tension in the fontanelles. If not corrected, irreversible neurological damage may occur.
  • Acute hydrocephalus is a neurosurgical emergency. It usually begins with headache that is increasing progressively, usually accompanied by nausea and vomiting. If it is not corrected it produces a decrease in the level of consciousness that can reach the coma. It can also cause inflammation of the optic nerves (papilloedema or papilledema) leading to blindness.
  • Chronic hydrocephalus can occur without a headache and is sometimes difficult to diagnose. In children, they can be manifested by school delays or visual impairment. In the adult it is manifested with a dementia that is associated with instability in walking and incontinence of sphincters, the so-called chronic hydrocephalus of the adult.


Diagnosis and treatment of hydrocephalus

The diagnosis of hydrocephalus is made through imaging, CT or MRI, where an increase in the cerebral ventricles is seen, but in other cases of chronic hydrocephalus, other types of tests such as the measurement of intracranial pressure may be necessary.

Treatment of hydrocephalus is based on correcting excess fluid to maintain adequate pressure inside the skull. When the cause is obstructive, it can be resolved either by eliminating this cause, the tumors, or by communicating the ventricles with the subarachnoid space through endoscopy through a small orifice, endoscopic ventriculostomy. When it is from another source, it is treated by the placement of a bypass, a tube associated with a pressure valve, from the ventricles to the peritoneal cavity or sometimes to the heart.

*Translated with Google translator. We apologize for any imperfection

By Dr. Ángel Horcajadas Almansa
Neurological Surgery

The prestigious Dr. Astride Almansa holds a PhD in Medicine and Surgery from the University of Granada. He specialized in neurosurgery at the Hospital Virgen de las Nieves of Granada between 1993 and 1998 under the direction of Dr. Ventura Arjona. After a brief stint as optional in this center moved to Malaga where he worked in the Carlos Haya Hospital in Malaga under the direction of Dr. Miguel A. Arráez. In 2015 he obtained the post of Head of the Vascular Pathology and Hydrocephalus Hospital Virgen de las Nieves of Granada, and in 2011 the Head of Service. In 2013 he began his private practice as a neurosurgeon at the Hospital Health Vithas Granada, so resignation to the head of service. Currently, served as a neurosurgeon at the Hospital Virgen de las Nieves Hospital and the Health Vithas, being in charge of the unit's first stereotactic radiosurgery.

He completed his specialization stays in domestic and overseas renowned centers such as Helsinki University Hospital, where he honed his skills in vascular pathology, Dr. Hernesniemi hand. He has extensive experience and expertise not only in vascular pathology, but also in hydrocephalus, pediatric pathology, brain and spinal tumors, neuroendoscopy, radiosurgery, and spinal pathology.

It has always combined his clinical work with teaching and research, having been tutor of residents of Neurosurgery Hospital Carlos Haya in Malaga for 7 years and is the author of numerous papers, several book chapters and more than 41 articles in professional journals . He is also coauthor of a software called intracranial pressure monitoring NeuroPICture, used in more than 18 centers across the country.

*Translated with Google translator. We apologize for any imperfection

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