Usually, hydrocephalus is considered to exist only when the width of fetal lateral ventricle is greater than 15mm and choroid plexus is reduced and suspended. When pregnant women consider hydrocephalus, doctors should carefully check whether the fetus has complications such as spina bifida, dysplasia of corpus callosum and widening of posterior cranial fossa. If not, it is simply lateral ventricular widening, not hydrocephalus.
What is hydrocephalus? Refers to severe ventricular dilatation with abnormal cerebrospinal fluid circulation and rapid progress, which can be divided into obstructive hydrocephalus and communicating hydrocephalus.
What to do: If the fetus is diagnosed with hydrocephalus during pregnancy, the pregnancy should be terminated as soon as possible to prevent the birth of hydrocephalus. Because the baby with hydrocephalus should pay special attention to treatment and nursing, which is a heavy burden for a family.
Reminder: Generally, the width of normal fetal lateral ventricle is 7.6mm±0.6mm by B-ultrasound. If the width of fetal lateral ventricle is 10~ 15mm, it is called mild lateral ventricle widening, and the widened part of lateral ventricle will be absorbed slowly with the growth and development of fetus.
The cause of hydrocephalus in infants is that the cerebrospinal fluid circulation channel is blocked.
1, congenital malformation
① Midbrain aqueduct stenosis, diaphragm formation or atresia, interventricular foramen atresia (median foramen or lateral space atresia of the fourth ventricle), cerebrovascular malformation, spina bifida, cerebellar tonsillar hernia, etc.
② Some hereditary metabolic diseases.
2. Fetal intrauterine infection
If these diseases are not controlled in time, the proliferation of fibrous tissue blocks the circulation channel of cerebrospinal fluid; Fetal intracranial inflammation can also cause adhesion and occlusion of cerebral cistern, subarachnoid space and arachnoid granules.
① Various viruses and protozoa: intrauterine infection of viruses (rubella virus, cytomegalovirus, herpes simplex virus, etc.). ) and environmental factors, Toxoplasma gondii has mild symptoms for pregnant women, but it has a great influence on the development of embryos. Toxoplasma gondii infection can cause hydrocephalus teratoma with aqueduct stenosis.
② Infectious meningitis caused by Treponema pallidum: Treponema pallidum easily infects the fetus through the placenta, leading to congenital syphilis. The disease is one of the clinical symptoms of congenital syphilis after birth.
3. Bleeding
Fibrosis after intracranial hemorrhage can cause hydrocephalus, and the absorption of intracranial hemorrhage after birth injury is not good, which is also a common cause of neonatal hydrocephalus.
In addition, hydrocephalus can also occur in arachnoid adhesion caused by subarachnoid hemorrhage after brain injury.
4. Tumor
Intracranial tumors can block any part of cerebrospinal fluid circulation, especially near the fourth ventricle. Neonatal tumors are rare, and glioma, choroid plexus tumor, ependymoma and neuroblastoma may appear in the later stage.
Hypersecretion of cerebrospinal fluid
The proliferation and secretion of choroid plexus in fetal lateral ventricle is strong, which causes the dysfunction of cerebrospinal fluid secretion in choroid plexus of ventricle, thus leading to hydrocephalus.
Cerebrospinal fluid absorption disorder
Hydrocephalus is a cerebrospinal fluid absorption disorder caused by fetal meningitis.
The symptom of hydrocephalus in infants is 1, and the head circumference is enlarged.
This is the main feature of infantile hydrocephalus, which is usually found gradually in 3-5 months. The head circumference of normal infants increased by 1.2- 1.3cm every month in the first six months. This disease is 2-3 times as much as it is, and some are obviously larger than normal at birth.
After the head circumference increases, the growth ratio of the head and trunk is out of balance, such as the head is too big and too heavy and hangs over the chest, the head is out of proportion to the face, the head is big and the face is small, the forehead is prominent, the jaw is narrow, the skull is thin, the superficial vein is bulging, and the scalp is shiny.
2. Open the fontanel.
When the head circumference increases, the fontanel (including the front fontanel and the back fontanel) also increases, the skull bone seam separates and the skull becomes thinner. Even transparent. There can be a broken pot sound on percussion "(similar to the ripe melon sound of watermelon). The vein in the temporal frontal region is swollen, the eyeball rotates downward, and the upper sclera (sunset shape) is often exposed.
3. Brain dysfunction
The baby with hydrocephalus is listless and can't lift its head. Severe cases may be accompanied by brain dysfunction, such as epilepsy, visual and olfactory disorders, nystagmus, strabismus, limb paralysis, mental retardation and so on.
4. Other symptoms
Infants with hydrocephalus may have frequent vomiting, irritability and poor eating due to compensatory enlargement of their heads. In addition, there may be brain degeneration, central paralysis of limbs, blindness caused by compression and atrophy of optic nerve, intellectual changes and developmental disorders. It is often complicated by deformities in other parts of the body. Some patients with congenital hydrocephalus will not have symptoms until adulthood.
Non-surgical treatment of hydrocephalus in infants
It is suitable for early or mild patients with slow development, aiming at reducing cerebrospinal fluid secretion or increasing body water excretion. The method is as follows:
① Use diuretics, such as acetazolamide, dihydrogram urine plug, furosemide, mannitol, etc.
② Repeated puncture and drainage through the anterior fontanel or lumbar spine.
③ For hydrocephalus caused by intracranial infection such as meningitis, dexamethasone can be injected intrathecally or orally, which may be effective for children who have recently fallen ill.
④ Restrict drinking water, and try to use drugs such as acetanilide, hydrochlorothiazide and triamterene to reduce CSF secretion and increase water excretion, which is helpful for temporary hydrocephalus. Include diuretics, dehydrating agents, etc. , suitable for cases that cannot be treated surgically, or as preoperative preparation.
Surgical therapy
Surgical treatment is the main treatment for hydrocephalus. For progressive hydrocephalus, the head is obviously enlarged, and the thickness of cerebral cortex exceeds 65438±0cm, which can be treated by surgery. Operations can be divided into the following categories:
① Surgery to reduce cerebrospinal fluid secretion: Cauterization after choroid plexus resection is rarely used now.
② Surgery to relieve the cause of ventricular obstruction: such as formation or expansion of cerebral aqueduct, median foramen incision, resection of intracranial space occupying lesions, etc.
③ Cerebrospinal fluid shunt: The purpose of the operation is to establish a cerebrospinal fluid circulation channel and relieve the accumulation of cerebrospinal fluid, and it is also used for communicating or non-communicating hydrocephalus. Commonly used shunt operations include lateral ventricle-cerebellomedullary cistern shunt, third ventricle ostomy, lateral ventricle-abdominal cavity, superior sagittal sinus, atrium and external jugular vein.
Attention: Infants with hydrocephalus after surgical treatment must pay attention to avoid complications such as shunt system blockage, infection, excessive or insufficient shunt, and split ventricle syndrome.
How to care for hydrocephalus infants after operation 1, closely observe consciousness, pupil changes, vital signs and limb activities, pay attention to observe and measure blood pressure, P, R and pupil changes, and record them on a special record sheet.
2. Pay attention to effective cooling measures above T & gt38.50C to reduce the oxygen consumption and basal metabolism of brain cells, and put ice packs, ice pillows, frozen infusion and ice packs on both sides of neck, armpit and groin. Patients with hypothermia should observe their complexion, P, R and sweating signs to prevent collapse caused by too much.
3. Observation of complications
(1) Observe whether there are symptoms of intracranial hypertension, such as slow weak P, rapid irregular R, headache, vomiting, elevated blood pressure, dilated pupils on one side, etc.
(2) Observe the surrounding skin, and report to the doctor for treatment if there is ulcer or cerebrospinal fluid leakage.
(3) Observe whether there is abdominal pain or abdominal discomfort.