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SURGERY REVERSES HYDROCEPHALUS

Q: I am 66 years old and I have symptomatic hydrocephalus. My neurologist has suggested that I have a shunt inserted. What is you opinion about me having this procedure performed at this time of my life?

-- Anonymous, Yorktown, Va.

A: I cannot specifically recommend what you should do. That's not only because I don't have enough information about your specific benefits and risks from this surgery, but also because I don't know how you would choose between them.

I will provide some background information that will help you discuss your situation with a specialist (presumably a neurosurgeon) and better understand you situation.

Hydrocephalus literally means water (hydro) in the head (cephalic) or brain. This is a normal state in which fluid baths the outside and inside of the brain. But the term is used in a medical sense to indicate that there is too much fluid.

This cerebrospinal fluid, the same fluid that baths the spinal cord, surrounds the outside of the spinal cord and brain and is contained in large cavities inside of the brain. These cavities are called ventricles. The fluid is produced by cells that line the ventricles and flows out of them to bath the rest of the brain and spinal cord.

Hydrocephalus is typically caused when the outlet from one of the ventricles is blocked, causing fluid build up and increased pressure. This buildup of pressure on brain is the primary cause of symptoms.

You have probably seen pictures of babies with much enlarged heads caused by the increased pressure. This enlargement can occur because the bones that make up the skull have not fused yet. Even so, the increasing pressure can squeeze the brain and cause major symptoms and death.

The increased pressure can cause the same problem in adults. And, since adult skulls are solid structures which cannot expand, it takes much less increase in fluid to cause a dangerous build up of pressure.

Possible symptoms include headaches, seizures, difficulty walking, incontinence and dementia. But, because the increasing dementia can develop slowly, it is often misdiagnosed as Alzheimer's disease.

Some experts suggest that almost 1 million people in North America have this condition, but only about one case in five is diagnosed. This is tragic, since the treatment for Alzheimer's does not help these people, and in many cases appropriate treatment can totally reverse the symptoms.

As you would expect, treatment for hydrocephalus entails lowering the pressure, which requires decreasing the build-up of fluid. Medications are not available that slow down the production of the fluid, and trying to surgically open up the blockage leads to scarring and return of the block.

So the best treatment of hydrocephalus is to insert a tube into the ventricle and run the tube into the abdominal cavity were the fluid drains and is absorbed. Although this sounds extremely dangerous, in skilled surgical hands it has a very high success rate. Unfortunately, sometimes the tube can become plugged and another operation is required.

I suggest that you find out how experienced the neurosurgeon is in doing this operation and discuss the outcomes (both good and bad) she or he has had. You then need to discuss the benefits and risks, and weigh them before making a decision.

Write to Allen Douma in care of Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y. 14207; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.

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