What is most symptomatic: the hydrocephalus or the tumour?

Consultant Paediatric Neurosurgeon, Mr Christopher Chandler provides parents with a detailed overview of what is involved when a child presents with hydrocephalus. This is a rare condition and can naturally cause huge anxiety, and so Mr Chandler explains what can be done, especially as the medical management of tumour associated hydrocephalus in children is controversial.and can vary considerably depending on the location and type of tumour that is present.

Mr Chandler describes how,  "The absolute priority is a careful and thorough clinical assessment of the patient by the clinical team to ascertain the neurological state of the child. Following this, the child requires neuroimaging, with CT scans often being the easiest and quickest scans to undertake. In all children with a tumour, magnetic resonance imaging (MRI) of the whole neuraxis is mandatory to determine the accurate location and extent of the tumour and the severity of the hydrocephalus."

However, the critical decision for the clinician at this stage is to determine what is most symptomatic: the hydrocephalus or the tumour. This depends on which symptoms are most life threatening danger to the child. "Swift treatment of the hydrocephalus takes the child out of danger and allows the neurosurgical team to plan the optimal management of the tumour, and often creates a safer operation to remove the tumour. It also frequently prevents the need to immediately undertake removal of the tumour, instead allowing time for the high intracranial pressure to subside."

The three main treatment options for children with hydrocephalus caused by a brain tumour are as follows:

1. External ventricular drain - this is quick and has the lowest complication rate,

2, Endoscopic third ventriculostomy - this involves a surgeon who is specially trained using complex equipment,

3. Ventriculo-peritoneal shunt - this is a bigger operation and is associated with the greatest number of complications.

Mr Chandler says that the objective for all treatment is to provide a permanent solution, and one that will not subsequently require a ventriculo-peritoneal shunt.

For further information see - Treating Hydrocephalus