Thursday, October 25, 2012

Hydrocephalus in developing countries

In Developing countries, causes of Hydrocephalus could be related to, or exacerbated by poverty and lack of proper healthcare. Undernourished mother run a higher risk of having premature babies, which, in turn, run a higher risk of having haemorrhaging. Meningitis in these countries is often the result of postnatal infections caused by poor delivery techniques or conditions. The inadequate treatment of these infections can result in Hydrocephalus. 

Treatment of Hydrocephalus in developing countriesHydrocephalus is most commonly treated by placement of a ventriculoperitoneal shunt (VP shunt). Shunts may be accompanied by a number of problems. They are prone to infection, especially within the first 3 months after operation. Shunt infections are life threatening and expensive and treatment is time-consuming. VP shunts are also prone to malfunction. One recent large multi-institutional study found that 40% of patients required a shunt revision within 2 years of initial shunt placement. Given a lifetime of shunt dependency, these problems are especially dangerous when access to competent care is difficult.
An alternative treatment is endoscopic third ventriculostomy (ETV). This treatment is minimally invasive. It also avoids infection, shunt dependency, the potential for shunt malfunction, and the cost of a shunt. ETV perforates the lower section of the third ventricle, which allows Cerebro-spinal fluid (CSF) to escape from the ventricles into the subarachnoid spaces, from which it is subsequently absorbed. If the hydrocephalus is caused by an obstruction to CSF flow within the ventricles, obstruction to the normal CSF outflow from openings in the IVth ventricle, or obstruction to CSF flow within the basal subarachnoid spaces around the fourth ventricle, the ETV will bypass any of these obstructions and relieve the problem if the normal CSF absorptive mechanisms are functioning adequately.

Source: International Federation for Spina Bifida and Hydrocephalus (IF)

World Spina Bifida and Hydrocephalus Day

October 25 is World Spina Bifida and Hydrocephalus Day. One can always find several babies in the Go Vap Orphanage with hydrocephalus, and a high percentage of these babies would not survive.

About Hydrocephalus

The ventricular system is made up of four ventricles connected by narrow passages.. Normally, the cerebro-spinal fuid (CSF) flows through the ventricles, exits into cisterns (closed spaces that serve as reservoirs) at the base of the brain, bathes the surfaces of the brain and spinal cord, and then reabsorbs into the bloodstream. 
CSF has three important life-sustaining functions: 1) to keep the brain tissue buoyant, acting as a cushion or "shock absorber"; 2) to act as the vehicle for delivering nutrients to the brain and removing waste; and 3) to flow between the cranium and spine and compensate for changes in intracranial blood volume (the amount of blood within the brain).
The balance between production and absorption of CSF is critically important. Because CSF is made continuously,  medical conditions that block its normal flow or absorption will result in an over-accumulation of CSF.  The resulting pressure of the fluid against brain tissue is what causes hydrocephalus. 
Hydrocephalus is sometimes referred to as 'water on the brain'. A watery fluid, known as cerebro-spinal fluid or CSF, is produced continuously inside each of the four spaces or ventricles inside the brain. The CSF normally flows through narrow pathways from one ventricle to the next, then out across the outside of the brain and down the spinal cord. The CSF is absorbed into the bloodstream and recirculates. The amount and pressure are normally kept within a fairly narrow range. If the drainage pathways are blocked at any point, the fluid accumulates in the ventricles inside the brain, causing them to swell - resulting in compression of surrounding tissue. In babies and infants, the head will enlarge. In older children and adults, the head size cannot increase as the bones which form the skull are completely joined together.

What is Hydrocephalus?

Hydrocephalus is a condition in which the primary characteristic is excessive accumulation of fluid in the brain. Although hydrocephalus was once known as "water on the brain," the "water" is actually cerebrospinal fluid (CSF) -- a clear fluid surrounding the brain and spinal cord. The excessive accumulation of CSF results in an abnormal dilation of the spaces in the brain called ventricles. This dilation causes potentially harmful pressure on the tissues of the brain.
Hydrocephalus is the buildup of too much cerebrospinal fluid in the brain. Normally, this fluid cushions the brain. When there is too much, though, it puts harmful pressure on the brain that tends to become enlarged, sometimes with little or no increase in intracranial pressure (ICP).