Brain Disorders & Therapy

Treatment Strategies for Pediatric Hydrocephalus: A Comprehensive Evaluation

Teroj Cakman^* Department of Neurology, University of Edinburgh, Edinburgh, United Kingdom
^*Correspondence: Teroj Cakman, Department of Neurology, University of Edinburgh, Edinburgh, United Kingdom, Email:

Received: 01-Sep-2023, Manuscript No. BDT-23-23178; Editor assigned: 04-Sep-2023, Pre QC No. BDT-23-23178(PQ); Reviewed: 18-Sep-2023, QC No. BDT-23-23178; Revised: 25-Sep-2023, Manuscript No. BDT-23-23178(R); Published: 03-Oct-2023, DOI: 10.35248/2168-975X.22.12.237

Description

Paediatric hydrocephalus, characterized by the accumulation of Cerebrospinal Fluid (CSF) within the brain's ventricles, is a complex neurological condition that requires timely and effective treatment to prevent potential complications. In the paediatric population, addressing hydrocephalus is particularly critical because the developing brain is more vulnerable to the detrimental effects of increased intracranial pressure. Various treatment modalities have been developed to manage paediatric hydrocephalus, with the most common approaches being shunt placement, Endoscopic Third Ventriculostomy (ETV), and minimally invasive techniques [1-3].

Paediatric neurosurgeons and paediatricians play a critical role in evaluating and selecting the most appropriate treatment strategy for each child with hydrocephalus. The objective is to provide effective CSF diversion or drainage while minimizing the risks and potential complications associated with the chosen approach.

Shunt placement

Shunt placement is the most established and widely used treatment for paediatric hydrocephalus. It involves the insertion of a surgically implanted device that diverts excess CSF from the brain's ventricles to another part of the body, typically the abdominal cavity, where it can be reabsorbed. Shunts can be classified into various types, including Ventriculoperitoneal (VP) shunts and Ventriculoatrial (VA) shunts [4-6].

Endoscopic third ventriculostomy

Endoscopic Third Ventriculostomy (ETV) is a surgical procedure that creates a new pathway for CSF to flow out of the brain's ventricles by making an opening in the floor of the third ventricle. This procedure is especially suitable for some paediatric patients with obstructive hydrocephalus, where the blockage occurs at the level of the aqueduct of Sylvius. ETV can be highly effective in select cases of paediatric hydrocephalus, particularly those with aqueductal stenosis. It offers the advantage of avoiding shunt placement and its associated risks and complications. ETV can promote a more natural CSF circulation pattern, potentially reducing the risk of certain complications [7].

Minimally invasive techniques

Advancements in technology have led to the development of minimally invasive techniques for managing paediatric hydrocephalus. These approaches include endoscopic procedures, such as Choroid Plexus Coagulation (CPC), ventriculocystostomy, and endoscopic septostomy. Minimally invasive techniques are associated with shorter hospital stays and reduced surgical trauma compared to traditional open procedures. They may be suitable for certain paediatric patients, especially those with cystic lesions or isolated obstructive components contributing to hydrocephalus. These techniques can be performed using smaller incisions, potentially resulting in less scarring and reduced postoperative pain [8-10].

Conclusion

The treatment of paediatric hydrocephalus is a complex and evolving field. Shunt placement, ETV, and minimally invasive techniques each have their advantages and limitations in managing this condition. The choice of treatment modality depends on various factors, including the underlying cause of hydrocephalus, patient age, anatomical considerations, and the experience of the medical team. As technology and surgical techniques continue to advance, ongoing research and clinical experience will contribute to refining treatment strategies and improving outcomes for paediatric patients with hydrocephalus. Tailored approaches that consider individual patient needs and characteristics will remain paramount in achieving the best possible results and optimizing the quality of life for these young patients as they grow and develop.

References

1. Canevelli M, Remoli G, Bacigalupo I, Valletta M, Toccaceli Blasi M, Sciancalepore F, et al. Use of biomarkers in ongoing research protocols on Alzheimer’s disease. J. Pers. Med. 2020;10(3):68.

   [Crossref] [Google Scholar]

2. Esteban FJ, Sepulcre J, de Mendizábal NV, Goñi J, Navas J, et al. Fractal dimension and white matter changes in multiple sclerosis. Neuroimage. 2007;36(3):543-549.

   [Crossref] [Google Scholar] [PubMed]   

3. Dichgans M, Zietemann V. Prevention of vascular cognitive impairment. Stroke. 2012;43(11):3137-3146.

   [Crossref] [Google Scholar] [PubMed]

4. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9(7):689-701.

   [Crossref] [Google Scholar] [PubMed]

5. Sweeney MD, Kisler K, Montagne A, Toga AW, Zlokovic BV. The role of brain vasculature in neurodegenerative disorders. Nat Neurosci. 2018;21(10):1318-1331.

   [Crossref] [Google Scholar] [PubMed]

6. Brosseron F, Krauthausen M, Kummer M, Heneka MT. Body fluid cytokine levels in mild cognitive impairment and Alzheimer’s disease: a comparative overview. Mol. Neurobiol. 2014;50:534-544.

   [Crossref] [Google Scholar] [PubMed]

7. DeTure MA, Dickson DW. The neuropathological diagnosis of Alzheimer’s disease. Mol. Neurodegener. 2019;14(1):1-8.

   [Crossref] [Google Scholar] [PubMed]

8. Yan T, Wang W, Yang L, Chen K, Chen R, Han Y. Rich club disturbances of the human connectome from subjective cognitive decline to Alzheimer's disease. Theranostics. 2018;8(12):3237.

   [Crossref] [Google Scholar] [PubMed]

9. Dai Z, Yan C, Li K, Wang Z, Wang J, Cao M, et al. Identifying and mapping connectivity patterns of brain network hubs in Alzheimer's disease. Cereb Cortex. 2015;25(10):3723-3742.

   [Crossref] [Google Scholar] [PubMed]

10. Das N, Spence JS, Aslan S, Vanneste S, Mudar R, Rackley A, et al. Cognitive training and transcranial direct current stimulation in mild cognitive impairment: a randomized pilot trial. Front. Neurosci. 2019;13:307.

    [Crossref] [Google Scholar] [PubMed]