Assistant Professor Department of Paediatrics ANMC

Hydrocephalus  Hydrocephalus is the buildup of too much cerebrospinal fluid in the brain  Normally, this fluid cushions the brain  Hydrocephalus can be congenital present at birth, or acquired present after birth  Congenital hydrocephalus  Acquired hydrocephalus

Hydrocephalus  CSF is formed primarily in the ventricular system by choroid plexus which is situated in the lateral, 3 rd and 4 th ventricles.  In a normal child 20ml/hr CSF is produced  Total volume of CSF in an infants is 50ml  In adults 150ml

Types of hydrocephalus  Obstructive or non communicating hydrocephalus  Obstruction within the ventricular system.  Nonobstructive or communicating hydrocephalus  Hydrocephalus resulting from the obliteration of subarachnoid cisterns or malfunction of arachnoid villi

Causes of hydrocephalus  Obstructive hydrocephalus  Aqueductal stenosis  Malformations  Tumors  Arnold chiari malformation  Dandy walker malformation

 Non obstructive hydrocephalus  Meningitis  Encephalitus  Papilloma  Subarachnoid hemorrhage

Symptoms include Headache Vomiting and nausea Blurry vision Balance problems Bladder control problems Thinking and memory problems

How is hydrocephalus diagnosed  Typically hydrocephalus is discovered by the child’s parents or pediatrician when the child’s head begins to rapidly swell and enlarge  Depending on child’s age (before six months),  X ray skull  Cranial Ultrasound  CT scan brain  MRI brain

Treatment  Medical management including;  Acetazolamide and furosemide may provide temporary relief by reducing the rate of CSF production

Treatment for hydrocephalus  Most often, hydrocephalus is treated surgically with the placement of a shunt to bypass the blockage that is causing the buildup, or to create a better flow of CSF  Types of shunt  VP shunt  VA shunt  VT shunt

Follow-up care is extremely important in tracking the progress of a child’s recovery. Pediatric neurosurgeon will schedule follow-up appointments to make sure your child is making a full recovery.

Spina bifida Spina bifida (Latin: "split spine") is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open If the opening is large enough, this allows a portion of the spinal cord to protrude through the opening in the bones

Spina bifida malformations fall into three categories: spina bifida occulta spina bifida cystica with meningocele spina bifida cystica with myelomeningocele The most common location of the malformations is the lumbar and sacral areas

Physical signs of spina bifida may include: Leg weakness and paralysis Orthopedic abnormalities (i.e., club foot, hip dislocation, scoliosis) Bladder and bowel control problems, including incontinence, urinary tract infections, and poor renal function Pressure sores and skin irritations Abnormal eye movement

Treatment There is no known cure for nerve damage caused by spina bifida To prevent further damage of the nervous tissue and to prevent infection, pediatric neurosurgeons operate to close the opening on the back

The spinal cord and its nerve roots are put back inside the spine and covered with meninges In addition, a shunt may be surgically installed to provide a continuous drain for the excess cerebrospinal fluid produced in the brain, as happens with hydrocephalus.

Surgeon Neurologist Urologist Opthalmoiogist Physical and occupational therapists

Prevention of spina bifida Primary prevention and secondary prevention Prognosis