Hydrocephalus and Other Disorders of the Spinal Fluid

Hydrocephalus

The brain and spinal cord float in a fluid called Cerebrospinal Fluid (CSF). This fluid is made in the ventricles, which are cavities or channels in the brain. The fluid then flows around the brain and spinal cord, and is later reabsorbed by the brain.

Hydrocephalus, water on the brain, is a condition in which the CSF is not reabsorbed as fast as it is made, or when there is a blockage of the CSF pathways leading to an enlargement of these channels which can cause increased pressure on the brain tissue and ultimately damage the brain.

Symptoms:

  • Headache
  • Loss of coordination/ balance
  • Impaired vision
  • Decline in memory, concentration and other thinking skills 

There are other conditions of large ventricles but without the elevated pressure. This can occur with aging and, when advanced, can also lead to problems related to walking and memory. This condition is known as Normal Pressure Hydrocephalus, or NPH.

Treatment:

Accurate diagnosis and identification of the different causes and conditions that affect CSF dynamics is crucial for treatment, which can include placement of catheters or shunts in the ventricles or the spinal canal to allow diversion of CSF and relieve pressure and obstruction.

At Baptist Health Neurosurgery Arkansas, we work with the latest imaging modalities to evaluate the CSF flow dynamics, including Cine MRI and nuclear studies, and utilize state-of-the-art technology and computer-assisted navigation for accurate shunt placement as well as endoscopic surgery for treatment of obstruction of CSF flow when indicated.

Pseudotumor cerebri

Pseudotumor cerebri (pronounced SOO-do-too-mur SER-uh-bry), also called idiopathic intracranial hypertension, is a condition in which the pressure in the brain is elevated with no clear cause in most cases, and with no expansion of the cerebral ventricles (channels in the brain that carry the spinal fluid or CSF).

Symptoms:

This elevated pressure can lead to

  • Headaches
  • Double and/or blurry vision
  • In untreated cases, visual loss

Treatment:

Accurate diagnosis requires advanced imaging and testing, including imaging of the brain venous drainage, a spinal tap to evaluate the CSF pressure and visual field examination. Treatment initially is medical, but progressive or advanced disease requires surgery.         

A collaboration between neuro-ophthalmologists, interventionalists and neurosurgeons is needed for successful treatment. Baptist Health Neurosurgery Arkansas provides such a comprehensive approach to Pseudotumor cerebri.

Chiari Malformation

Chiari (pronounced key-are-ee) malformation is a condition in which the lower part of the brain, the cerebellum, herniates down through the base skull and into the spinal canal. The herniated tissue compresses the brainstem, blocking and altering the normal spinal fluid pathway which, with time, can cause fluid buildup within the tissue of the spinal cord, known as syringomyelia, or in the brain (hydrocephalus). 

Symptoms:

  • Headache
  • Neck pain
  • Dizziness
  • Arm numbness
  • Fatigue

Treatment:

Chiari affects children and adults and comes in different variants. Treatment options depend on the type of malformation and severity of symptoms. Most patients show mild symptoms and only need monitoring and medications, which can be effective. However, progressive symptoms or advanced disease may require surgery to relieve pressure on the brainstem and re-establish CSF flow.

An accurate diagnosis is needed to avoid unnecessary surgery, and prompt treatment, when indicated, is important to prevent permanent injury to the nervous system.

Baptist Health Neurosurgery Arkansas provides neurosurgical evaluation and treatment of patients with Chiari malformation. We collaborate with other specialists and therapists to identify the exact cause of symptoms and ensure accurate diagnosis.