Perspective - Journal of Neurology and Neurorehabilitation Research (2023) Volume 8, Issue 6
Understanding hydrocephalus: Current perspectives and future directions
Ariane Reinaldo*
Department of Neurorehabilitation, Bina Nusantara University, Jakarta, Indonesia
- *Corresponding Author:
- Ariane Reinaldo
Department of Neurorehabilitation,
Bina Nusantara University,
Jakarta,
Indonesia
E-mail: reinaria@gmail.com
Received: 20-Nov-2023, Manuscript No. JNNR-23-120546; Editor assigned: 21-Nov-2023, JNNR-23-120546 (PQ); Reviewed: 05-Dec-2023, QC No. JNNR-23-120546; Revised: 20-Jan-2024, Manuscript No. JNNR-23-120546 (R); Published: 27-Jan-2024, DOI: 10.35841/aajnnr-9.1.186
Citation: Reinaldo A. Understanding hydrocephalus: Current perspectives and future directions. J Neurol Neurorehab Res. 2024;9(1):186.
Introduction
Hydrocephalus is a neurological condition characterized by an abnormal accumulation of Cerebro Spinal Fluid (CSF) within the brain's ventricles. It affects individuals of all ages, from infants to the elderly, and can result from various underlying causes, including congenital abnormalities, infections, tumors, or trauma. The accumulation of CSF leads to increased pressure within the skull, potentially causing damage to brain tissues and impairing neurological functions [1].
This condition poses significant challenges in diagnosis, treatment, and long-term management, often requiring a multidisciplinary approach involving neurologists, neurosurgeons, radiologists, and other specialists. The primary goal of managing hydrocephalus is to alleviate symptoms, reduce intracranial pressure, and prevent further neurological damage [2,3].
Description
Diagnosis
The diagnosis of hydrocephalus involves a combination of clinical evaluation, imaging studies, and sometimes invasive procedures. Neurological examination helps identify symptoms such as headaches, nausea, vomiting, and visual disturbances, which are common indicators of increased intracranial pressure [4].
Imaging techniques, such as MRI (Magnetic Resonance Imaging) and CT (Computed Tomography) scans play a crucial role in visualizing the ventricular system and assessing the extent of CSF accumulation. These imaging modalities help determine the underlying cause and aid in planning appropriate treatment strategies [5].
Treatment
The management of hydrocephalus often necessitates surgical intervention. The most common surgical procedure involves the insertion of a shunt system-a flexible tube with a valve-into the brain's ventricles to divert excess CSF to another part of the body, usually the peritoneal cavity (ventriculoperitoneal shunt) or the heart (ventriculoatrial shunt) [6,7].
Shunt surgeries have significantly improved the prognosis for individuals with hydrocephalus by regulating CSF flow and reducing intracranial pressure. However, these procedures are not without complications. Shunt malfunctions, infections, and blockages are frequent issues that require prompt medical attention and sometimes additional surgeries.
Management and long-term care
Following shunt placement, individuals with hydrocephalus require lifelong monitoring and management. Regular clinical evaluations, imaging studies, and adjustments to the shunt system are necessary to ensure its proper functioning. Moreover, patients and caregivers should be vigilant in recognizing symptoms of shunt malfunction, such as headaches, changes in behavior, or visual disturbances [8].
Besides shunt surgeries, alternative treatments like Endoscopic Third Ventriculostomy (ETV) may be considered in specific cases. ETV involves creating a new pathway for CSF to bypass obstruction within the ventricular system without using a shunt.
Challenges and future directions
Despite advancements in surgical techniques and technology, several challenges persist in the management of hydrocephalus. Shunt-related complications remain a significant concern, impacting patients' quality of life and requiring frequent medical interventions. Additionally, optimizing shunt design and materials to minimize complications remains an on-going area of research [9,10].
Further understanding of the underlying mechanisms of hydrocephalus is crucial for developing targeted therapies and non-invasive interventions. Innovative approaches, such as stem cell therapy or gene therapy, hold promise in addressing the root causes of hydrocephalus and potentially reducing the need for invasive surgical procedures.
Collaborative efforts between clinicians, researchers, and industry partners are essential to drive advancements in diagnostics, treatment modalities, and long-term care for individuals affected by hydrocephalus.
Conclusion
Hydrocephalus presents complex challenges in neurological care, necessitating a multidisciplinary approach for diagnosis, treatment, and on-going management. While shunt surgeries have significantly improved outcomes, complications remain a concern, emphasizing the need for continual advancements in therapeutic strategies.
Future research should focus on unravelling the pathophysiology of hydrocephalus to develop targeted and less invasive treatments. Through collaborative efforts and innovation, the aim is to enhance the quality of life for individuals affected by this condition and provide more effective and durable solutions in the management of hydrocephalus.
References
- Warf BC. Hydrocephalus in Uganda: The predominance of infectious origin and primary management with endoscopic third ventriculostomy. J Neurosurg. 2005;102(1):1-5.
[Crossref] [Google Scholar] [PubMed]
- Kahle KT, Kulkarni AV, Limbrick DD, et al. Hydrocephalus in children. Lancet. 2016;387(10020):788-799.
[Crossref] [Google Scholar] [PubMed]
- Oi S, Shimoda M, Shibata M, et al. Pathophysiology of long-standing overt ventriculomegaly in adults. J Neurosurg. 2000;92(6):933-940.
[Crossref] [Google Scholar] [PubMed]
- Simon TD, Riva-Cambrin J, Srivastava R, et al. Hospital care for children with hydrocephalus in the United States: Utilization, charges, comorbidities, and deaths. J Neurosurg. 2008;1(2):131-137.
[Crossref] [Google Scholar] [PubMed]
- Khan F, Rehman AU, Haq EU, et al. Management outcome of hydrocephalus using ventriculoperitoneal shunt. J Ayub Med Coll Abbottabad. 2010;22(2):62-65.
- Drake JM, Kestle JR, Milner R, et al. Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery. 1998;43(2):294-303.
[Crossref] [Google Scholar] [PubMed]
- Klimo P, Thompson CJ, Baird LC, et al. Pediatric hydrocephalus: Systematic literature review and evidence-based guidelines. Part 7: Antibiotic-impregnated shunt systems versus conventional shunts in children: A systematic review and meta-analysis. J Neurosurg Pediatr. 2014;14(S1):53-59.
[Crossref] [Google Scholar] [PubMed]
- Kahle KT, Kulkarni AV, Warf BC, et al. Hydrocephalus in children. Nat Rev Dis Primers. 2016;2:16008.
- Buxton N, Macarthur D, Mallucci C, et al. Neurological outcomes in a prospective randomized trial of ventriculoperitoneal shunt function. Neurosurg. 1999;45(2):258-263.
- Klebe D, McBride D, Krafft PR, et al. Posthemorrhagic hydrocephalus development after germinal matrix hemorrhage: Established mechanisms and proposed pathways. J Neurosci Res. 2020;98(1):105-20.
[Crossref] [Google Scholar] [PubMed]