Hydrocephalus refers to the excessive accumulation of water in the brain. The skull enlarges noticeably in children.

Cerebrospinal fluid (CSF), located in the brain and spinal cord, protects the brain and spinal cord from concussions. In addition, CSF prevents harmful substances in the blood from passing to the brain and spinal cord through a mechanism called the blood-brain barrier. CSF production and absorption are continuous. Absorbed fluid passes into the systemic circulation through the veins. If the balance between the production and absorption of CSF in the skull is disturbed, and if the fluid cannot be absorbed sufficiently, hydrocephalus develops.

How and why does hydrocephalus develop? 

Hydrocephalus develops in children due to either an increase in CSF production or insufficient absorption of CSF or obstruction in the pathway of CSF. Increased intracranial pressure syndrome (ICPS) occurs due to excessive fluid increase in the head.

If the increase in the fluid is excessive before the sutures connecting the skull bones are closed, the head circumference will expand noticeably. This is a compensation mechanism. Thus, it is tried to reduce the damage to the brain by an excessive increase in intracranial pressure. If hydrocephalus develops acutely or after the sutures are closed, the ICPS will be severe and the damage to the brain tissue will increase.

Hydrocephalus is most common between 0-2 years of age. It occurs as a result of brain infection and bleeding, tumor, and head trauma in older children and adults.

Symptoms of hydrocephalus

In the first two months following the birth, the head grows excessively, the scalp becomes thinner, the veins become more prominent, and vomiting, drooping of the eyes, and convulsions are seen. Later, visual, sensory, and movement disorders are added to these symptoms. If the brain stem is involved, vital signs such as breathing and swallowing difficulties may occur.

Hydrocephalus diagnostic methods

Hydrocephalus can be detected by ultrasound imaging in the womb. Head circumference should be measured regularly after birth. Diagnosis can be made with ultrasound without closure of the anterior fontanelle, and with CT or MRI after closure.

Surgical treatment of hydrocephalus

Excessively increased fluid in the head is transferred to another part of the body by placing a shunt (tube), thus preventing pressure and fluid accumulation. The shunt, which is placed in the chambers where the cerebrospinal fluid accumulates, is passed under the skin and extended to the abdomen or heart cavity, and the fluid is evacuated.

Hydrocephalus rehabilitation 

Hydrocephalus rehabilitation should be carried out systematically from infancy to adulthood with a holistic team understanding. Rehabilitation should be carried out in cooperation with the family, and care, development, joint and body posture protective measures should be taught to relatives.

First of all, it is tried to keep the head of the child according to the developmental stages and to provide the balance of sitting and standing. Both trunk and arm and leg muscles are strengthened. Children who are suitable for robotic rehabilitation are allowed to walk with robotic walking devices at the age of 3-5 and hence, walking is corrected.

Occupational therapy is used to adapt them to daily life. At the same time, the occupational therapist helps the child with sensory integration therapy to gain functions faster, increase their skills, and gain cognitive and educational development.