Hydrocéphalie

The hydrocéphalie is derived from the hydro Greek words, which means water, and kephalê, which wants to say head. It is a severe neurological anomaly, defined by the increase in the volume of spaces containing the céphalo-rachidian Liquide (LCR): ventricles cerebral and spaces under arachnoïdien. This dilation can be due to a hypersecretion of LCR, a defect of resorption, or a mechanical obstruction of the lanes.

History

The hydrocéphalie was described for the first time by Hippocrates, but could be treated successfully only with the 20th century, with the advent of the suitable neurosurgical techniques.

Communicating Hydrocéphalie

It is also named hydrocéphalie normotensive which is a dilation of the ventricular system in the presence of a more or less normal pressure on the level of the liquid céphalorachidien. The dynamics of the liquid céphalorachidien is disturbed. It can be secondary with a hemorrhage, itself due to an arteriovenous malformation, a hemorrhage under-arachnoïdienne, with a traumatism or a problem idiopathic.

Diagnosis

Signs of confusion (insanity);
an ataxia with walk;
incontinence (disorders sphinctériens);
Tomodensitométrie or IRM (ventricular dilation)

Treatment

The evolution can be stopped by a medical care or a ventricular surgical operation of derivation.

Obstructive Hydrocéphalie

It is accompanied by an intracranial hypertension and represents a medical emergency by main risk of cerebral engagement, imposing the installation of a ventricular derivation in urgency. Its causes are:

the cerebral Tumor S (benign or malignant) compressing the third and/or the fourth ventricle cerebral (from where blocking of and the accumulation lanes of LCR in the ventricles),
the congenital hydrocéphalie, by cerebral malformation,
a tumor of the plexuses choroid (extremely rare), person in charge of a hypersecretion of LCR,
the bulk-heading meninx (within the framework of a Meningitis),
the méningée Hemorrhage.
This type of hydrocéphalie is the prerogative of the infant and is declared by an increase in the cranial perimeter, a convexity of fontanelles, characteristic eyes in sunset. This hydrocéphalie malformative often accompanies the defects by closing (dysraphies) of the tube neural (méningocèles, myélo-méningocèles).

Hydrocéphalie with normal pressure

It is also known under the name of syndrome of Adams and Hakim.

Physiopathology

It is a variety of hydrocéphalie related to a low obstruction of the lanes of the LCR (downstream from the openings of the fourth ventricle, in general on the level of the cisterns of the base), met at the old subject. It is not accompanied by intracranial hypertension, its Symptôme S is of progressive and insidious appearance.

Diagnosis

Turbid of the balance and walk (the earliest sign) with walk with small steps, in antépulsion. To the maximum, walk and the station upright are impossible. Important fact, the neurological examination does not show any driving disorder nor sensitive.
Turbid Sphincter iens: Incontinence (late).
Insanity: it also late, it is connected with a frontal Syndrome.

These signs are not very specific of hydrocéphalie: the clinical diagnosis is difficult, it is the Medical imagery which brings the best certainty.

Complementary examinations

the cerebral scanner (without injection of Iode) finds a dilation quadriventriculaire without widening of the cortical furrows (what makes it possible to differentiate hydrocéphalie and atrophies cerebral)
the lumbar Ponction evacuation often makes it possible to improve temporarily the Symptôme S (in particular disorders of walk). Its analysis reveals a normal LCR.

Treatment

It is a neurosurgical treatment consistent in the installation of a derivation ventriculo-péritonéale (DVP), this derivation is internal between the ventricular system and the Péritoine (or the Cœur, more rarely) where will drain the excess of LCR. The effects are inconstant from one patient to another: driving recovery is often satisfactory if the treatment is early (disorders of walk without insanity if turbid sphinctériens), in the event of good answer with the lumbar Ponction evacuation, and in the event of hydrocéphalie secondary (with a Traumatisme, a Infection, etc). When blocking is beyond the holes of Monro and the third ventricle, one currently carries out a ventriculo-cisternostomy (VCS) under endoscopy transventriculaire and by breaking down the floor of V3 using a inflatable small baloon. The interest is to often avoid the installation of a valve of derivation source of dysfunction. The risks of these interventions are same as those related to any surgical operation.

: It can be declared a few days or a few weeks after the operation. The gravity of the infection can be very variable and dictates the treatment. Often local treatments of the wound are enough, but it happens that one must réintervenir and/or treat then the patient by antibiotics.
Hemorrhagic (blood clot): It is generally presented in the first 48 hours after the operation. A hématome can be created anywhere on the trajectory of insertion of the probe or the drain. According to its gravity, this hématome either will be supervised or will require a surgical recovery. This can appear by a neurological aggravation due to compression coming from the clot.
In the event of hyperdrainage of the valve of derivation, it can also occur a hématome under-dural requiring its evacuation and the temporary clampage of the valve.
Obstruction, obturation: This delayed dysfunction is not foreseeable and can appear even after years.

External bond

Hydrocéphalie

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