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Best Hospitals for Hydrocephalus treatment in India

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Hydrocephalus is a condition where there is an accumulation of cerebrospinal fluid in the brain. Though more commonly occurring in infants and small children, this condition also affects adults and the elderly as well. About one in five hundred infants are born with this condition.

The excessive accumulation of the cerebrospinal fluid results in an abnormal increase in the size of the head. This increase in the size of the head is prominently seen in babies. This happens because the natural sutures between the skull bones are still more pliable. In adults an abnormal increase in the size of the head is not seen as the bones have fused completely.

It is important to understand that hydrocephalus is not a disease by itself. It is only a manifestation of an underlying disorder that prevents the proper circulation of the cerebrospinal fluid.

It is important to always note that hydrocephalus is a condition, rather than a disease in itself. It is an indication of an underlying problem in the circulatory system of the cerebrospinal fluid (CSF) in the brain.

 

Cerebrospinal fluid is present in the meninges and in the ventricles, which are spaces between the brain. The primary function of the cerebrospinal fluid is to act as a ‘shock absorber’ for the brain. It protects the brain by acting as a cushion for the brain. It also provides nourishment to the brain tissue, regulates the intracranial pressure and removes waste products.
The cerebrospinal fluid flows through the ventricles and empties into a reservoir located around the brain stem. From this reservoir, it is absorbed back into the blood. Any obstruction in this process can cause a hindrance with the re-absorption of the fluid into the blood and it ends up accumulating around the brain. This accumulation results in hydrocephalus.

Causes of Hydrocephalus:

Hydrocephalus can be present right from the time of birth or develop at any time during a person’s life. Hydrocephalus present during birth is known as Congenital Hydrocephalus. The main causes for it are:

·       Aqueductal stenosis is the most common cause of congenital hydrocephalus. In this condition the ‘aqueduct of Sylvius’ that connects the third and fourth ventricle gets blocked. This results in improper drainage of CSF.

·       Neural tube defects like spina bifida where the spinal cord is found exposed during birth. This results in the downward movement of the cerebellum and the fourth ventricle from its normal position.

·       Arachnoid cysts are sacs filled with CSF and lined by the arachnoid membrane. The cyst can be found in the lining of ventricles and may obstruct the proper flow of CSF.

·       Dandy-Walker Syndrome is a development abnormality of the brain in which the cerebellum is poorly developed. This can cause hydrocephalus amongst small children.

·       Chiari malformations is a condition in which there is an abnormal downward displacement of the brain stem which pushes against the spinal cord. This can result in hydrocephalus as well.


Acquired hydrocephalus can occur at any age after birth. In this condition there is no developmental abnormality of the brain. Rather it is caused by trauma to the brain or intrinsic factors that develop at a later stage of life. Some of the common causes of acquired hydrocephalus are 

       Trauma due to head injury

       Intraventricular haemorrhage in babies

       Brain tumours 

       Arachnoid cysts 

       Infections of the brain and associated structures like meningitis 

Normal pressure hydrocephalus is a condition that occurs in the elderly. In this condition there is enlargement of the ventricles without a corresponding increase in intra-ventricular pressure. The exact cause is not known. 

Compensated hydrocephalus is a type of hydrocephalus that remains asymptomatic for a long time. 

There is currently no known treatment to cure or even prevent hydrocephalus. However, with new technology. Treatment methods and early detection, people with hydrocephalus can lead a full and active life.

Surgery is the best and only option currently to treat Hydrocephalus. There are two major surgeries:

SHUNT PLACEMENT:

In this procedure a drainage tube called a shunt is placed inside the ventricle. The other end of the tube is connected to the peritoneal cavity or to a chamber of the heart. From here the cerebrospinal fluid is reabsorbed. The shunt is placed inside the skin and remains there for the rest of the life. The shunt tube contains a valve that regulates the flow of the fluid.

The surgery is done under general anaesthesia. The duration of surgery will be about three to four hours. The period of hospitalisation may range from five to seven days.

Shunt placement can create various complications and periodic evaluation of its function is necessary. A hydrocephalus shunt repair surgery may be necessary to rectify the complications. A replacement of the shunt may be necessary if the surgery is done in infancy. This is done according to the growth of the person. More than one replacement surgeries may be necessary according to the growth.

Other complications include:

• Shunt blockage- This results in increased build-up of CSF in the brain. A revision surgery may be necessary to correct the problem.

• Shunt infection- Signs of infection include headache, vomiting, tenderness in the shunt line, stiffness of neck, irritability and abdominal pain. Appropriate antibiotics are necessary to clear the infection.

• Improper position of the shunt- The position of the shunt may not be ideal for proper drainage. A corrective surgery may have to be done to reposition it.

• Bleeding around the shunt position site

• Leakage of CSF around the shunt

 

ENDOSCOPIC THIRD VENTRICULOSTOMY:


In this procedure a hole is made in the floor of the brain to evacuate the accumulated CSF. The CSF drains to the surface of the brain from the ventricles from where it is reabsorbed. It is more commonly done in conditions where the cause of hydrocephalus is obstructive in nature.

The surgery is a minimally invasive one as it is done with the help of an endoscope. A camera fitted in the endoscope allows the surgeon to see the area of the surgery. The surgery takes about an hour or two. The period of hospitalisation is about three to four days. 

Both shunt surgery and Endoscopic third ventriculostomy are performed in all major hospitals in India for hydrocephalus. The period of hospitalisation is about a week at best. A person coming from abroad will need to spend about two to three weeks in India. So, along with the cost of the surgery, patients will also need to factor in additional costs such as travel fare, hotel stay for themselves and their travelling partner(s), food and other expenses.

On an average Hydrocephalus treatment in India will cost between 4000-7000 USD.

The cause of hydrocephalus is as yet unknown. Although rare, yet, hydrocephalus can be inherited genetically. Congenital hydrocephalus runs in families. Even though there is no definite proof, yet it is believed that genetic defects that can cause congenital hydrocephalus can be passed from one or both parents to their child(ren). Experts have found a connection between a rare genetic disorder known as the L1 syndrome and hydrocephalus. L1 syndrome causes aqueductal stenosis which in turns causes an obstruction in the flow of the CSF and leads to hydrocephalus.

Hydrocephalus symptoms:

The symptoms displayed by hydrocephalus may vary according to the age of onset. Most of the symptoms are associated with the pressure changes in the brain due to the enlargement of ventricles. The symptoms may also vary according to the area of the brain affected by the pressure.


The signs may include 

• An abnormally large head disproportionate with the rest of the body

• A rapid increase in the circumference of the head

• Soft bulges in the centre of the head


The symptoms in infants are:

• Retarded growth

• Vomiting

• Constant Sleepiness

• Irritability

• Fits or Seizures

• Downward gaze also referred to as ‘sunsetting of the eyes’

• Reduced muscle tone and strength

• Decreased response to touch

• Poor eating habits

 

In older children the symptoms may include:

• Persistent headache and irritability

• Blurring of vision

• A fixed downward gaze 

• Tiredness and lethargy

• Vomiting

• Postural imbalance and uncoordinated muscle movements

• Loss of appetite

• Seizures

• Urinary incontinence

• Behavioural changes

• Personality changes

 

In young adults, the symptoms could be:

• Persistent Headache

• Lethargy

• Postural balance and lack of muscular coordination

• Urinary incontinence or increased frequency of urination

• Impairment of vision

• Decline in cognitive skills

• Memory problems

• Lack of concentration 

 

In the elderly, the symptoms could be:

• Memory lapses

• Loss of cognitive skills

• Difficulty in walking and a feeling of the feet getting ‘stuck’

• Poor coordination of muscles

 

Hydrocephalus is a condition where there is an accumulation of cerebrospinal fluid in the brain. Though more commonly occurring in infants and small children, this condition also affects adults and the elderly as well. About one in five hundred infants are born with this condition.

The excessive accumulation of the cerebrospinal fluid results in an abnormal increase in the size of the head. This increase in the size of the head is prominently seen in babies. This happens because the natural sutures between the skull bones are still more pliable. In adults an abnormal increase in the size of the head is not seen as the bones have fused completely.

It is important to understand that hydrocephalus is not a disease by itself. It is only a manifestation of an underlying disorder that prevents the proper circulation of the cerebrospinal fluid.

It is important to always note that hydrocephalus is a condition, rather than a disease in itself. It is an indication of an underlying problem in the circulatory system of the cerebrospinal fluid (CSF) in the brain.

 

Cerebrospinal fluid is present in the meninges and in the ventricles, which are spaces between the brain. The primary function of the cerebrospinal fluid is to act as a ‘shock absorber’ for the brain. It protects the brain by acting as a cushion for the brain. It also provides nourishment to the brain tissue, regulates the intracranial pressure and removes waste products.
The cerebrospinal fluid flows through the ventricles and empties into a reservoir located around the brain stem. From this reservoir, it is absorbed back into the blood. Any obstruction in this process can cause a hindrance with the re-absorption of the fluid into the blood and it ends up accumulating around the brain. This accumulation results in hydrocephalus.

Causes of Hydrocephalus:

Hydrocephalus can be present right from the time of birth or develop at any time during a person’s life. Hydrocephalus present during birth is known as Congenital Hydrocephalus. The main causes for it are:

·       Aqueductal stenosis is the most common cause of congenital hydrocephalus. In this condition the ‘aqueduct of Sylvius’ that connects the third and fourth ventricle gets blocked. This results in improper drainage of CSF.

·       Neural tube defects like spina bifida where the spinal cord is found exposed during birth. This results in the downward movement of the cerebellum and the fourth ventricle from its normal position.

·       Arachnoid cysts are sacs filled with CSF and lined by the arachnoid membrane. The cyst can be found in the lining of ventricles and may obstruct the proper flow of CSF.

·       Dandy-Walker Syndrome is a development abnormality of the brain in which the cerebellum is poorly developed. This can cause hydrocephalus amongst small children.

·       Chiari malformations is a condition in which there is an abnormal downward displacement of the brain stem which pushes against the spinal cord. This can result in hydrocephalus as well.


Acquired hydrocephalus can occur at any age after birth. In this condition there is no developmental abnormality of the brain. Rather it is caused by trauma to the brain or intrinsic factors that develop at a later stage of life. Some of the common causes of acquired hydrocephalus are 

       Trauma due to head injury

       Intraventricular haemorrhage in babies

       Brain tumours 

       Arachnoid cysts 

       Infections of the brain and associated structures like meningitis 

Normal pressure hydrocephalus is a condition that occurs in the elderly. In this condition there is enlargement of the ventricles without a corresponding increase in intra-ventricular pressure. The exact cause is not known. 

Compensated hydrocephalus is a type of hydrocephalus that remains asymptomatic for a long time. 

There is currently no known treatment to cure or even prevent hydrocephalus. However, with new technology. Treatment methods and early detection, people with hydrocephalus can lead a full and active life.

Surgery is the best and only option currently to treat Hydrocephalus. There are two major surgeries:

SHUNT PLACEMENT:

In this procedure a drainage tube called a shunt is placed inside the ventricle. The other end of the tube is connected to the peritoneal cavity or to a chamber of the heart. From here the cerebrospinal fluid is reabsorbed. The shunt is placed inside the skin and remains there for the rest of the life. The shunt tube contains a valve that regulates the flow of the fluid.

The surgery is done under general anaesthesia. The duration of surgery will be about three to four hours. The period of hospitalisation may range from five to seven days.

Shunt placement can create various complications and periodic evaluation of its function is necessary. A hydrocephalus shunt repair surgery may be necessary to rectify the complications. A replacement of the shunt may be necessary if the surgery is done in infancy. This is done according to the growth of the person. More than one replacement surgeries may be necessary according to the growth.

Other complications include:

• Shunt blockage- This results in increased build-up of CSF in the brain. A revision surgery may be necessary to correct the problem.

• Shunt infection- Signs of infection include headache, vomiting, tenderness in the shunt line, stiffness of neck, irritability and abdominal pain. Appropriate antibiotics are necessary to clear the infection.

• Improper position of the shunt- The position of the shunt may not be ideal for proper drainage. A corrective surgery may have to be done to reposition it.

• Bleeding around the shunt position site

• Leakage of CSF around the shunt

 

ENDOSCOPIC THIRD VENTRICULOSTOMY:


In this procedure a hole is made in the floor of the brain to evacuate the accumulated CSF. The CSF drains to the surface of the brain from the ventricles from where it is reabsorbed. It is more commonly done in conditions where the cause of hydrocephalus is obstructive in nature.

The surgery is a minimally invasive one as it is done with the help of an endoscope. A camera fitted in the endoscope allows the surgeon to see the area of the surgery. The surgery takes about an hour or two. The period of hospitalisation is about three to four days. 

Both shunt surgery and Endoscopic third ventriculostomy are performed in all major hospitals in India for hydrocephalus. The period of hospitalisation is about a week at best. A person coming from abroad will need to spend about two to three weeks in India. So, along with the cost of the surgery, patients will also need to factor in additional costs such as travel fare, hotel stay for themselves and their travelling partner(s), food and other expenses.

On an average Hydrocephalus treatment in India will cost between 4000-7000 USD.

The cause of hydrocephalus is as yet unknown. Although rare, yet, hydrocephalus can be inherited genetically. Congenital hydrocephalus runs in families. Even though there is no definite proof, yet it is believed that genetic defects that can cause congenital hydrocephalus can be passed from one or both parents to their child(ren). Experts have found a connection between a rare genetic disorder known as the L1 syndrome and hydrocephalus. L1 syndrome causes aqueductal stenosis which in turns causes an obstruction in the flow of the CSF and leads to hydrocephalus.

Hydrocephalus symptoms:

The symptoms displayed by hydrocephalus may vary according to the age of onset. Most of the symptoms are associated with the pressure changes in the brain due to the enlargement of ventricles. The symptoms may also vary according to the area of the brain affected by the pressure.


The signs may include 

• An abnormally large head disproportionate with the rest of the body

• A rapid increase in the circumference of the head

• Soft bulges in the centre of the head


The symptoms in infants are:

• Retarded growth

• Vomiting

• Constant Sleepiness

• Irritability

• Fits or Seizures

• Downward gaze also referred to as ‘sunsetting of the eyes’

• Reduced muscle tone and strength

• Decreased response to touch

• Poor eating habits

 

In older children the symptoms may include:

• Persistent headache and irritability

• Blurring of vision

• A fixed downward gaze 

• Tiredness and lethargy

• Vomiting

• Postural imbalance and uncoordinated muscle movements

• Loss of appetite

• Seizures

• Urinary incontinence

• Behavioural changes

• Personality changes

 

In young adults, the symptoms could be:

• Persistent Headache

• Lethargy

• Postural balance and lack of muscular coordination

• Urinary incontinence or increased frequency of urination

• Impairment of vision

• Decline in cognitive skills

• Memory problems

• Lack of concentration 

 

In the elderly, the symptoms could be:

• Memory lapses

• Loss of cognitive skills

• Difficulty in walking and a feeling of the feet getting ‘stuck’

• Poor coordination of muscles