What will happen if hydrocephalus is not treated? As we all know, the human brain is a very important organ, so we should pay attention to any problems in the brain, among which hydrocephalus is a disease of the brain. Many people want to know if this disease will have any effect if it is not treated. Let's take a look together.
What will happen if hydrocephalus is not treated 1
What will happen if hydrocephalus is not treated
1, human brain tissue will be compressed by liquid for a long time, which will make brain tissue degenerate, shrink and become thinner, thus leading to the decline of brain function.
2. When there is water in the brain, it will increase the intracranial pressure. Moreover, the brain tissue will become thinner because of excessive pressure, which will flatten the gyrus and shallow the sulcus.
If hydrocephalus is not treated in time, it will affect children's intellectual development. Only when it is discovered and handled in time in the initial stage can it be possible to restore the child to normal state.
How to treat hydrocephalus?
At present, hydrocephalus has drug treatment and surgical treatment. Usually, doctors will make corresponding treatment plans according to the specific conditions of patients. For early, mild and slow-developing hydrocephalus patients, medication is usually used. The principle of treatment is to reduce cerebrospinal fluid secretion and promote water excretion. For patients with excessive brain pressure, ineffective drug treatment and severe hydrocephalus, surgery is usually needed.
What will happen if hydrocephalus is not treated? 2 Clinical symptoms of hydrocephalus
Typical symptoms are headache, vomiting, blurred vision, optic papilla edema, occasional diplopia, dizziness and seizures. Some patients have slow pulse, high blood pressure, disordered breathing and pupil changes; Some patients may have eye movement disorder, pyramidal tract sign, muscle tension change and meningeal irritation sign; There are manifestations of abdominal distension syndrome, such as vomiting, constipation, gastrointestinal bleeding, neurogenic pulmonary edema, diabetes insipidus, brain sodium retention, brain salt wasting syndrome and so on.
Causes of hydrocephalus in infants
First, bleeding.
Fibrosis after intracranial hemorrhage can lead to hydrocephalus. Intracranial hemorrhage after birth injury is malabsorption and a common cause of neonatal hydrocephalus, which is often ignored. Subarachnoid hemorrhage after brain injury leads to arachnoid adhesion and hydrocephalus. If you want to get more information about diseases, you can search for "Sunshine Health School" in the application market, download and install it, and get more knowledge about diseases at any time.
Second, congenital malformation.
Congenital malformation of infants may be related to parents' exposure to certain chemical radioactive substances, fever in early pregnancy, taking certain drugs, abnormal fetal position and polyhydramnios. The common hydrocephalus caused by malformation is spina bifida and midbrain aqueduct stenosis.
Third, the tumor.
Intracranial tumors can block any part of cerebrospinal fluid circulation, which is more common near the fourth ventricle. Neonatal intracranial tumors are relatively rare, and glioma, choroid plexus papilloma, ependymoma and neuroblastoma may appear in the future.
Fourth, infection.
Such as purulent meningitis, tuberculous meningitis and ventriculitis. The occurrence of hydrocephalus is due to the proliferation of fibrous tissue blocking the circulation hole of cerebrospinal fluid, especially at the adhesion between the fourth ventricle hole and the subarachnoid space at the bottom of the brain.
Five, cerebrospinal fluid absorption disorder.
Such as fetal meningitis and hydrocephalus caused by cerebrospinal fluid absorption disorder.
Hydrocephalus is a common complication of bacterial meningitis, its incidence is second only to subdural effusion, and it is more common in infants who are not treated properly or treated too late. Fifty-four children with bacterial meningoencephalitis aged 65,438+0 months to 5 years were studied. It was found that 39.0% of children had early complications, including subdural effusion (47.6%) and hydrocephalus (65,438+04.2%). Streptococcus pneumoniae meningitis is a risk factor for hydrocephalus, which often indicates poor treatment effect. It is reported that Listeria monocytogenes is related to hydrocephalus caused by bacterial meningitis. Meningococcus is still the common cause of hydrocephalus. This article mainly reviews the pathogenesis and treatment of bacterial meningitis complicated with hydrocephalus.
1, the mechanism of hydrocephalus complicated by bacterial meningitis
Due to serious infection, the absorption of cerebrospinal fluid by arachnoid granules is blocked, forming communicating hydrocephalus; Inflammatory exudation can cause subarachnoid adhesion, block the aqueduct, interventricular foramen, median foramen and lateral foramen of the fourth ventricle, affect cerebrospinal fluid circulation, and then cause obstructive hydrocephalus. It is reported that hydrocephalus caused by bacterial meningitis is mostly traffic hydrocephalus, and obstructive hydrocephalus is only a minority.
Step 2 deal with
At present, the treatment of bacterial meningitis is mainly early application of antibiotics. Bacterial meningitis caused by Escherichia coli and Streptococcus pneumoniae has different clinical characteristics. The possibility of Streptococcus pneumoniae infection should be considered in patients with severe fever (>: 39℃), disturbance of consciousness and elevated white blood cell count. Such children are sensitive to vancomycin. The onset age is 3 months, with moderate and mild fever, frequent convulsions and white blood cell count of12×109/L. It should be considered that the probability of Escherichia coli infection is high and it is sensitive to meropenem. Other treatments include adjuvant use of steroids and intensive care. Despite the current standard treatment, the mortality and the incidence of serious complications of severe bacterial meningitis are still 17. 1% ~ 77.5%. The most common cause of death of bacterial meningitis is intractable intracranial hypertension with cerebral hernia and brain stem compression. Hydrocephalus is also one of the reasons for the increase of intracranial pressure.
Hydrocephalus in patients with bacterial meningitis often indicates poor prognosis, and even studies have shown that hydrocephalus is an independent risk factor for bacterial meningitis death. A study shows that compared with patients without hydrocephalus, 56% of patients with hydrocephalus have a CSF white blood cell count lower than1×109/L. The white blood cell count in cerebrospinal fluid (CSF) below 1× 109/L has been determined as an index to predict severe inflammation and poor prognosis. However, related animal studies show that due to the lack of white blood cells in cerebrospinal fluid, large bacterial load in cerebrospinal fluid is more likely to cause intracranial complications. Therefore, children whose white blood cell count is lower than 1× 109/L should be alert to hydrocephalus and intervene as soon as possible.
From the clinical manifestations, if the meningitis patients have decreased consciousness, persistent high fever, seizures, increased intracranial pressure, or the clinical symptoms can not be alleviated or even aggravated after using appropriate antibiotics, they should be alert to the occurrence of hydrocephalus and should be examined by head imaging in time. For patients with mild ventricular enlargement, surgical intervention is not recommended at this time if there is no possibility of spontaneous remission. For communicating hydrocephalus, lumbar puncture can measure cerebrospinal fluid pressure, and repeated lumbar puncture can effectively reduce intracranial pressure, but we need to be alert to the risk of cerebral hernia. For patients with obstructive hydrocephalus, lumbar puncture is forbidden, and surgical intervention such as ventricular drainage, ventriculoperitoneal shunt and colostomy can be taken.
There are three main surgical treatments for hydrocephalus after bacterial meningitis, namely ventricular drainage, ventriculoperitoneal shunt and third ventriculostomy (ETV). Combined with relevant reports at home and abroad, the surgical treatment methods and complications of hydrocephalus after bacterial meningitis are analyzed as follows.
(1) Ventricular drainage
At present, the most commonly used surgical method of ventricular drainage is external drainage with Omega capsules. Under general anesthesia, an arc incision with a length of about 3 cm was made around the intersection of left anterior coronary suture 1.5 cm and 3 cm beside the midline, the scalp was cut to stop bleeding, the flap was retracted, the skull was drilled, the bleeding was stopped with bone wax, and the dura mater was perforated with electrocautery. Take a guide needle from the capsule section of Ommaya, and slowly insert it from the dura foramen to the connection direction of bilateral external auditory canal. Suture the periosteum to fix the ventricular segment, cut the ventricular segment properly, connect the Ommaya capsule, and tie the fixed joint with silk thread. Free the cap aponeurosis, and then suture the scalp incision layer by layer with absorption line. The whole process remains sterile and airtight.
Traditional ventricular puncture and drainage can be placed for a short time, and the probability of intracranial infection is high, while Omega capsules can be placed in the human body for a long time with few complications. The external drainage of Omega capsule can quickly relieve intracranial pressure, promote the circulation and renewal of cerebrospinal fluid, and make the biochemical and routine of cerebrospinal fluid return to normal, which provides an opportunity for surgical treatment such as ventriculoperitoneal shunt or ETV, and is often used when hydrocephalus is complicated after bacterial meningitis, and the biochemical and routine of cerebrospinal fluid are abnormal. However, most children with hydrocephalus after bacterial meningitis have abnormal cerebrospinal fluid biochemical routine, which is not suitable for immediate shunt operation. Therefore, when the cerebrospinal fluid of children with hydrocephalus after bacterial meningitis is abnormal, Omega capsules are usually placed for external drainage first, and then shunt or ostomy is performed after the cerebrospinal fluid returns to normal.
At present, children's surgical intervention mostly adopts ventricular drainage, but the report of adults is not effective. According to German research, 9 out of 65,438+00 meningitis patients with hydrocephalus were treated with ventricular drainage, and a study in Taiwan Province province of China described that 7 out of 26 patients were treated with ventricular drainage. None of these studies describe continuous lumbar puncture, but the mortality rate can still reach 50% after interventional ventricular drainage, and the clinical manifestations have not improved significantly.
(2) Ventricular-peritoneal shunt
This operation is the most widely used surgical treatment at present. Operation mode: After the children are satisfied with anesthesia, they are disinfected routinely and covered with towels. Take the intersection of 1.0 cm before the coronal suture and 2.5 cm on the right side of the midline as the center, make a small arc incision of about 4.0 cm, cut the scalp completely and open the flap. After drilling the skull, puncture the lateral ventricle and make a subcutaneous tunnel through the lower layer of the cap aponeurosis along the head, neck and chest. Abdominal surgery at the same time. The shunt tube passes through the subcutaneous tunnel of the head, neck, chest and upper abdomen, and the abdominal end of the shunt tube is placed in the free abdominal cavity of the lower abdomen to suture the surgical incision.
Ventricular-peritoneal shunt is widely used in communicating and obstructive hydrocephalus. This operation has a wide range of applications, but there are many complications. Common complications include abdominal infection (peritonitis, appendicitis), intracranial infection (including ependymolitis), shunt obstruction and abnormal position. Pan Xinhua and He Lizhen performed ventriculoperitoneal shunt on 26 patients with hydrocephalus after bacterial meningitis. Results There were 2 cases of infection around shunt, 2 cases of shunt obstruction and 5 cases of abnormal cerebrospinal fluid. In addition, other reports of postoperative shunt blockage include abdominal end blockage (omentum wrapping, abdominal end folding, abdominal segment floc blockage) and shunt valve blockage. Postoperative infection (intracranial infection, incision infection). Complications such as prolapse of the end of the ventricle and subdural effusion can be cured by resetting the shunt or pulling out the original shunt to drain the ventricle, and then performing ventriculoperitoneal shunt again after controlling the infection. The complications of abdominal organs can be treated by corresponding surgery, such as appendectomy with appendicitis.
(3)ETV
Whether it is used to treat hydrocephalus after bacterial meningitis is still controversial. Operation mode: the child is in supine position, with head height 15. After satisfactory anesthesia, the towel was disinfected routinely, and an arc incision was made on the right forehead to cut the scalp cortex and subcutaneous tissue, open the flap and push the periosteum. Generally, a cranial hole with a diameter of about 1 cm is drilled 2 ~ 3 cm away from the midline and 2 cm in front of the right coronal suture to form a cranial hole, and the dura mater is cut horizontally, and the needle is punctured with a brain needle. Point the imaginary lines of the two external auditory canals slightly to the center line and enter about 5 cm. After seeing cerebrospinal fluid outflow, pull out the brain puncture needle, insert the endoscope sheath along the puncture channel, take out the needle core, insert the endoscope into the lateral ventricle, and enter the third ventricle through the interventricular foramen. Fistula was performed in the thinnest avascular area in the center behind the funnel recess in front of the bilateral mastheads, and the edge of the stoma was cauterized with special bipolar electrocoagulation. If necessary, the stoma can be expanded with Fogarty balloon. The fistula was enlarged to 5 ~ 8 mm, and the whole operation was washed repeatedly with 9 g/L normal saline at 37℃. Seal the puncture channel with gelatin sponge or fibrin glue, suture the dura mater and close the skull layer by layer.
ETV is mainly used for obstructive hydrocephalus and surgical treatment of infantile obstructive hydrocephalus complicated with bacterial meningitis. Postoperative complications included cerebrospinal fluid leakage, ependymositis, transient fever and seizures, and did not recur after symptomatic treatment. In addition, meningitis and ventriculitis caused by bleeding and infection after ETV, transient or persistent diabetes insipidus, weight gain, precocious puberty caused by hormone balance disorder caused by hematoma, subdural effusion and hypothalamus injury after operation, hemiplegia caused by thalamus injury during operation or hematoma after operation, memory disorder caused by vault injury, oculomotor nerve paralysis caused by oculomotor nerve injury, or cognitive decline and consciousness disorder in different degrees have also been reported.
3. Summary
At present, there are few reports on the surgical treatment of hydrocephalus after bacterial encephalitis in infants, and there are no clear reports on its surgical indications and contraindications, which need further study and discussion. At present, the surgical treatment of hydrocephalus after bacterial meningitis is mostly ventriculoperitoneal shunt, but this kind of operation has many complications. The implantation of shunt tube is not conducive to the physical and mental health of children, and it has to be replaced many times with the growth and development. For mild hydrocephalus or hydrocephalus after bacterial meningitis with abnormal biochemical routine of cerebrospinal fluid, Omega capsules can be implanted for external drainage first. If the child's hydrocephalus is controlled, shunt surgery can be avoided. If the child's hydrocephalus is not controlled, external drainage can be done first. When the biochemical routine of cerebrospinal fluid returns to normal, shunt operation and ETV can be performed again. At present, ETV is mainly used for obstructive hydrocephalus, because it is more in line with the physiological cycle and avoids foreign body implantation, and it is increasingly favored by neurosurgeons. However, its application in hydrocephalus caused by bacterial meningitis is still controversial, but due to its advantages, the application of ETV in hydrocephalus caused by bacterial meningitis is still worth popularizing. Therefore, the treatment of children's bacterial meningitis complicated with hydrocephalus needs more research and guidance.