What is congenital brain puncture?

In newborns, even if there is ventricle enlargement or hydrocephalus, the anterior fontanelle may still be sunken, especially in infants with low birth weight. Due to dehydration, the head may be smaller than normal. In addition, premature babies are prone to intraventricular hemorrhage. These all need our attention. So, what is hydrocephalus in children? Let’s take a look at it below.

Hydrocephalus in children refers to a disease in which the volume of cerebrospinal fluid increases, leading to increased intracranial pressure. The clinical symptoms are enlargement of the head, opening of the anterior fontanelle and cranial sutures. It is more common in children between 6 months and 7 years old. How to treat hydrocephalus in children? See what the doctor says.

Overview of Hydrocephalus in Children

Hydrocephalus refers to the accumulation of excessive cerebrospinal fluid in the ventricles and subarachnoid space. If a large amount of cerebrospinal fluid accumulates in the subarachnoid space on the surface of the cerebral hemispheres, it is called subdural hygroma or subdural effusion. Excessive fluid accumulation in the ventricular system is called intraventricular hydrocephalus. Hydrocephalus in children is more common in newborns and infants, and is often accompanied by enlargement of the ventricular system, increased intracranial pressure and increased head circumference.

What causes hydrocephalus in children?

1. Causes

Hydrocephalus can be caused by the following three factors: excessive production of cerebrospinal fluid; obstruction of the cerebrospinal fluid pathway and cerebrospinal fluid absorption disorder. The cause of congenital hydrocephalus is currently believed to be obstruction of the cerebrospinal fluid circulation pathway. The causes of obstruction can be divided into two categories: congenital developmental abnormalities and non-developmental causes.

1. Congenital developmental abnormalities

(1) Cerebral aqueduct stenosis, gliosis and septum formation: All of the above lesions can lead to infarction of the cerebral aqueduct, which is the most common cause of congenital hydrocephalus. It is usually sporadic. Sex-linked hereditary aqueduct stenosis accounts for only 2% of all congenital hydrocephalus.

(2) Arnold-Chiari malformation: The cerebellar tonsils, medulla oblongata and fourth ventricle herniate into the spinal canal, which obstructs the circulation of cerebrospinal fluid and causes hydrocephalus, often complicated by spina bifida and meningocele.

(3) Dandy-Walker malformation: hydrocephalus caused by congenital occlusion of the middle and lateral foramina of the fourth ventricle.

(4) Flat skull base: often combined with Arnold-Chiari malformation, which blocks the outlet of the fourth ventricle or the ambient cistern and causes hydrocephalus.

(5) Others: Lissencephaly, chondrodysplasia, brain perforation, fifth and sixth ventricular cysts, etc. can all cause hydrocephalus.

2. Non-developmental causes Among congenital hydrocephalus, congenital developmental abnormalities account for about 2/5, while non-developmental causes account for 3/5. Intracranial hemorrhage caused by neonatal hypoxia and birth trauma, and adhesions secondary to meningitis are common causes of congenital hydrocephalus. Intracranial tumors and cysts in neonates, especially posterior cranial fossa tumors and choroid plexus papilloma also often lead to hydrocephalus.

What are the symptoms of hydrocephalus in children and how to diagnose it?

The main movement abnormalities include spastic paralysis of the limbs, mainly in the lower limbs. In mild cases, the heels are tense and the feet drop. In severe cases, there is a spastic gait, also known as a scissors gait, which is sometimes difficult to distinguish from cerebral palsy because the anterior part of the third chamber, hypothalamus, and infundibulum are affected.

Various endocrine dysfunctions may occur, such as precocious or delayed puberty and stunted growth, as well as other symptoms of decreased hormone levels. In addition, patients with syringomyelia and hydrocephalus often have lower limb movement disorders, and when syringomyelia symptoms are accompanied by spinal cord dysplasia, scoliosis is often present.

The ventricles often enlarge and the head circumference increases abnormally within 6 to 14 weeks after the neonatal period, but this process is also self-limited. Although an abnormal increase in a child's head circumference is an important sign of hydrocephalus, there is no absolute relationship between the two. It is necessary to understand the entire clinical process including the fetal perinatal period and continuously observe the ventricular dilatation. B-ultrasound is a simple, non-traumatic, repeatable and reliable method for observing patients with hydrocephalus.

After the diagnosis of progressive hydrocephalus is established, neuroimaging examinations such as cranial CT and magnetic resonance imaging (MRI) can be performed to exclude intracranial tumors, congenital malformations, and cerebrospinal fluid obstructive lesions. Water-soluble contrast agents and radionuclide scanning are helpful in the diagnosis of obstructive hydrocephalus, but their use is generally limited.

What should be paid attention to before treating hydrocephalus in children?

1. Treatment

1. Medication

(1) Drugs that inhibit cerebrospinal fluid secretion: such as acetazolamide (acetazolamide), 100 mg/(kg·d), reduces cerebrospinal fluid secretion by inhibiting Na+-K+-ATPase in choroid plexus epithelial cells.

(2) Diuretics: furosemide, 1 mg/(kg·d).

The above methods should be the first choice for children under 2 years old with mild hydrocephalus, and about 50% of patients can control the disease.

2. Non-shunt surgery In 1918, Dandy first used the method of removing the choroid plexus of the lateral ventricle to treat hydrocephalus. However, since the production of cerebrospinal fluid is not limited to the choroid plexus tissue, and the choroid plexus of the third and fourth ventricles was not removed, the effect of the surgery was uncertain, so it was discontinued. Third ventriculostomy is a procedure that creates a direct channel between the floor or terminal plate of the third ventricle and the interpeduncular cistern to treat cerebral aqueduct obstruction.

Contraindications:

① Intracranial infection cannot be controlled by antibiotics;

② Patients with cerebrospinal fluid protein exceeding 50mg% or fresh bleeding;

③ Those with abdominal inflammation or ascites;

④ Those with infection on the skin of the neck and chest.

How to prevent hydrocephalus in children?

Nothing special, early detection and early treatment.

What should children with hydrocephalus eat?

The main thing is to eat more nutritious food and avoid eating overly stimulating food.

It is worth reminding the editor that drug treatment is generally only suitable for mild hydrocephalus. Although some infants or children do not have symptoms of hydrocephalus, the patients may have progressive ventricular enlargement. Although some children have the ability to compensate, it will eventually affect the development of the children's nervous system. Drug therapy is generally used to temporarily control the development of hydrocephalus before shunt surgery.