Ventricles &

Hydrocephalus

Dr. Sameera Mushtaq

Course
 Learning Objectives:

• Introduction
• Flow, Production & Absorption of CSF
• Hydrocephalus (intro, types)
• Pathogenesis and sign symptoms
 Ventricular System:

The ventricular system is a set of four

interconnected cavities (ventricles) in the BRAIN
where Cerebrospinal fluid (CSF) is produced.
• 2 Lateral ventricles
• Third ventricle
• Fourth ventricle
Ventricular System :
 Ventricular System :

• The ventricles are filled with ❖ Daily production # 400-500

cerebrospinalfluid (CSF)
• It is clear, colorless bodily fluid
• Bathes and cushions the brain and
spinal cord within their bony
confines.
ml/day
❖ Normal value #150 to 270ml
❖ Normal ICP # 5 to 15 mmHg
❖ Upper limit # 20 to 25 mmHg(
time to treat)
 Production

CSF is produced by
modified ependymal cells
of the choroid plexus
found in all components
of the Ventricular system.
system.
Flow of CSF:
Flow of CSF :
 Absorption of CSF:

Fluid flows around the

subarachnoid space to after which it passes
be reabsorbed via the into the venous sinus through the jugular Major venous system.
arachnoid villi(or vein
granulation villi)
Absorption of CSF :
 Functions of CSF :

• Provides cushion to the brain

• Provides Glucose and oxygen to neuron constantly. (neuron cannot
live without it for more than 3-4 mins)
• CSF nourishes nervous tissue (even blood cannot nourish directly
neuron)
• CSF decrease sudden pressure on delicate tissues
 Clinical Anatomy:

Hydrocephalus
 Hydrocephalus:

• Hydrocephalus is an abnormal buildup of

cerebrospinal fluid (CSF) in the ventricles of
the brain.
• The fluid is often under increased pressure and can
compress and damage the brain.
• Some estimates report one to two of every 1,000 babies are
born with hydrocephalus.
• If skull is still pliable so it may enlarge.
Hydrocephalus :
Hydrocephalus::

hydro-, meaning "water",

and ceph, meaning "head"
 Pathogenesis:

• Obstruction of CSF
• Increased production
• Decreased absorption
Hydrocephalus:
 Types of hydrocephalus

Non-obstructive,
or
communicating

Obstructive, or
Overproduction
non-
hydrocephalus
communicating
 Types of hydrocephalus:

Non-obstructive, or communicating:

• Hydrocephalus occurs when the CSF flows out of the

chambers of the brain (ventricles) and into the spinal canal,
but it is not reabsorbed normally by the tissue surrounding
the brain and spinal cord.
• Sometimes this type of hydrocephalus corrects itself.
• Obstruction is normally at subarachnoid area.
 Causes of communicating hydrocephalus :

• Subarachnoid/ intraventricular haemorrhage

• Meningitis and congenital absence of arachnoid villi.
• Scarring and fibrosis of the subarachnoid space following infectious,
inflammatory, or hemorrhagic events can also prevent resorption of
CSF, causing diffuse ventricular dilatation.
• Traumatic head injury
• Thickening of arachnoid
 Types of hydrocephalus :

Obstructive, or non-communicating:
• Hydrocephalus occurs when the CSF does not flow properly
between or out of the brain ventricles because of an
obstruction, such as from a malformation or narrowing.
 Causes of non communicating hydrocephalus

• Foramen of Monro obstruction( colloid cyst)

• Narrowing of The aqueduct of Silvius normally (e.g.,
atresia, ependymitis, haemorrhage, tumour) most
common
• Fourth ventricle obstruction (Chiari malformation)
• Foramen of Luschka and foramen of Magendie
obstruction (dandy walker malformation)(Cerebellar
malformation)
• fourth ventricular cyst)
 Types of hydrocephalus :

Overproduction hydrocephalus.
• rare cases
• the brain tissue makes too much CSF and the body can't
properly absorb or distribute the high amount of fluid.
 Normal pressure hydrocephalus :

• (NPH) is a particular form of communicating hydrocephalus, characterized

by enlarged cerebral ventricles, with only intermittently elevated
cerebrospinal fluid pressure.
• As gradual onset so no rise in pressure.
• Continuous intraventricular pressure recordings required.
• Occurs in mid-aged people.
• Characterized by dementia, gait disturbance, and involuntary urination.
• Misdiagnosed as Alzheimer’s, Dementia, and Parkinsonism.
Types of hydrocephalus :
 Sign and symptoms

• The diagnostic signs and symptoms of hydrocephalus depend upon the age
of the person:
• In infants the most obvious sign of hydrocephalus is usually
• Abnormal large head,
• Vomiting,
• Sleepiness,
• Irritability,
• An inability to look upwards,
• Seizures and bulging fontanelle.
 Sign and symptoms:

In older children and adults there is no head enlargement from hydrocephalus, but symptoms
may include
• Headache
• Nausea
• Blurred Vision
• Problems With Balance
• Delayed Development
• Short, High-pitched Cries
• Personality Changes
• Facial Changes
• Crossed Eyes
• Headaches
• Muscle Spasms
• Poor Coordination.
 Complication of Hydrocephalus:

• Brain Damage
• Seizures
• Infection
• Nerve Damage
• Impaired Growth
• Enlarged Head
 Complication of Hydrocephalus

• Other complication come from surgical treatment e.g. ;

• Surgery to remove the blockage, attempt to decrease CSF can leads to
• Infection
• Severe Headache
• Brain Damage
• Postoperative seizures
 Diagnostic Test for Hydrocephalus:

• Ultrasound
• CT-Scan
• MRI
• Lumbar Puncture
• Intracranial Pressure Monitoring
• Neuropsychology
 Treatment:

Cerebral shunts
• Involves the placement of a ventricular catheter (a tube made of silastic),
into the cerebral ventricles to bypass the flow obstruction/malfunctioning
arachnoidal granulations and drain the excess fluid into other body cavities,
from where it can be resorbed.
• Peritoneal cavity (ventriculo-peritoneal shunt)
• Right atrium (ventriculo-atrial shunt)
• Pleural cavity (ventriculo-pleural shunt)
• Gallbladder
Cerebral shunts
 Treatment

Endoscopic third
ventriculoscopy(ETV)
• surgically created opening in the
floor of the third ventricle allows
the CSF to flow directly to the basal
cisterns, thereby shortcutting any
• obstruction, as in aqueductal
stenosis.
 Learning outcomes:

✓ Flow of CSF
✓ Production of CSF
✓ Absorption of CSF
✓ Hydrocephalus (intro, types, pathogenesis and sign symptoms)
: