My Little Girl (Rosey) was born with Hydrocephalus Spinal Bifida. Hydrocephalus means there is a build-up of fluid around the brain. Like a bathtub with the water on and a partially clogged drain, this fluid on the brain can’t drain fast enough. This fluid is made by special brain cells to protect the brain and spinal cord. When there is too much fluid, it can be dangerous. Rosey had To Much Fluid .. Most of the time, it is easy for doctors to see that there is too much fluid on the brain. There are special fluid-filled pockets, or cavities, called ventricles, that get too big when there is too much liquid. In some cases, it isn’t as easy to see. (In Roseys case; it was) There are cases where there may be a little more fluid than normal←, and the person has little or no signs of a problem. In these rare cases, neurosurgeons might treat the problem where other types of doctors would not. Part of the reason why this might happen is because experts disagree on when the best time is to treat the problem. The most common treatment for hydrocephalus is to insert a tube, called a shunt,(Rosey had a Shunt) to drain excess fluid from the head to another place where the body can remove it naturally. (In her case; the stomach ) Shunts have valves that regulate both the direction and amount of fluid that is drained. All shunts have three parts: 1) a ventricular catheter to reach the area where there is too much fluid, 2) a valve to control flow (there are many types) and 3) tubing to carry the fluid from one place in the body to another. Types of shunts The most common type of shunt is the ventriculo-peritoneal (VP) shunt. This shunt drains fluid from the ventricle to the body’s abdomen( what Rosey has) . Other types that are less common are: Ventriculo-atrial (VA) shunts —VA shunts move the fluid to a vein, usually in the neck or under the collarbone; Ventriculo-pleural shunts — These shunts move fluid to the chest around the lungs; and Ventriculo-gall bladder shunts — These shunts move fluid to the gall bladder. There are several types of shunt valves. All of them work by controlling the amount of fluid that is drained. Most are made to work automatically when fluid pressure in the head gets too high. Some valves also may have special devices to keep too much fluid from draining. Experts have not yet learned which type of shunt is best for whom. So neurosurgeons usually pick ones that they think are best. Shunts can be put into one of these places in the head: The edge of the soft spot Above and behind the ear The back of the head Experts don’t know if one place is better than another. So where to put the shunt also is up to what the surgeon thinks is best. About 80 percent of people with Spina Bifida have hydrocephalus that needs treatment. Almost all shunts are put in during the first days or weeks after birth. Sometimes the shunt will be inserted at the time of the initial back closure. A child who doesn’t need a shunt by the time they are five months old probably will never need one. Signs of shunt problems Signs of hydrocephalus (or of shunt malfunction) in infants may include: Rapid head growth; Full or tense soft spot (fontanelle); Unusual irritability; Repeated vomiting; Crossed eyes; An inability to look up; Periods in which the baby stops breathing (called apnea); Difficulty swallowing; A hoarse or weak cry; Difficulty in keeping the infant awake; and Any worsening brain function. A head ultrasound, Computed Tomography (CT) scan or a Magnetic Resonance Imaging (MRI) scan will show this fluid build-up, but a shunt still may not be working right even if it doesn’t show up on a CT or MRI scan. New, long-term treatments using small endoscopes may eliminate the need for a shunt. All patients with hydrocephalus should be seen by a neurosurgeon at least every one to two years. Most people with Spina Bifida and shunted hydrocephalus will need the shunt for life. The most common problem with shunts is that they can get blocked up, break or come apart. About 40 percent of shunts will fail and need changing (or revision) within one year, 60 percent within five years and 80-85 percent within 10 years. About 20 percent of people with Spina Bifida will need more than one shunt revision. The signs of shunt problems in people with Spina Bifida are different for each person. This can make it hard for families and health care providers to know what’s going on. The most common sign of a shunt problem is headache. Vomiting and nausea can happen, too, but not always. Less common signs of a shunt problem include: Seizures (either the onset of new seizures or an increase in the frequency of existing seizures); A significant change in intellect, school performance or personality; Back pain at the Spina Bifida closure site; Worsening arm or leg function (increasing weakness or loss of sensation, worsening coordination or balance and/or worsening orthopedic deformities); Increasing scoliosis; Worsening speech or swallowing difficulties; and Changes in bowel or bladder function. Shunt malfunction can look like any of the signs of a Chiari malformation or spinal cord tethering. In fact, when brain or spinal cord function gets worse and there is no other clear cause, health care providers should check to see if there are shunt problems. To see if there is a problem with a shunt, health care providers will study images of the brain (usually a CT scan or, for children under one year, a head ultrasound). MRI scans can show shunt problems, but they usually are not necessary, are more expensive and may require sedation or anesthesia. When ventricles start to get too big, it is a strong sign that the shunt is not working right. It is important to know that some people (between 5 and 15 percent) with Spina Bifida may have very few signs or even no visible change in the size of the ventricles when the shunt is not working correctly. On the other hand, some people with shunted hydrocephalus can develop the slit (or stiff) ventricle syndrome. For these people, too much fluid drainage leads to very small (or slit) ventricles. In these cases, experts think that the walls of the ventricles temporarily block the shunt catheter. This leads to a series of temporary shunt malfunctions without any visible increase in the size of the ventricles. Families and health care providers must pay close attention to a person’s symptoms, especially if they are similar to those that were present with previous shunt problems. Spinal bifida is: spi·na bif·i·da /ˈspīnə ˈbifidə/ noun a congenital defect of the spine in which part of the spinal cord and its meninges are exposed through a gap in the backbone. It often causes paralysis of the lower limbs, and sometimes mental handicap. (NOT Rosey She was not paralyzed by spinal bifida.) **What causes Spina Bifida? ** No one knows for sure. Scientists believe that genetic and environmental factors act together to cause the condition. Meaning it may run in the fathers, or mothers genesis. **What are the different types of Spina Bifida?** Occult Spinal Dysraphism (OSD) Infants with this have a dimple in their lower back. Because most babies with dimples do not have OSD, a doctor has to check using special tools and tests to be sure. Other signs are red marks, hyperpigmented patches on the back, tufts of hair or small lumps. In OSD, the spinal cord may not grow the right way and can cause serious problems as a child grows up. Infants who might have OSD should be seen by a doctor, who will recommend tests. Spina Bifida Occulta It is often called “hidden Spina Bifida” because about 15 percent of healthy people have it and do not know it. Spina Bifida Occulta usually does not cause harm, and has no visible signs. The spinal cord and nerves are usually fine. People find out they have it after having an X-ray of their back. It is considered an incidental finding because the X-Ray is normally done for other reasons. However, in a small group of people with SBO, pain and neurological symptoms may occur. Tethered cord can be an insidious complication that requires investigation by a neurosurgeon.
Posted on: Thu, 05 Dec 2013 05:47:30 +0000