THE COMPASS

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 Ventricular System

If you have ever heard the surgeons talk about “the lakes of the brain” then you have heard about ventricles. Our brain is constantly producing a fluid called CSF, or cerebrospinal fluid. CSF flows around the brain and spine. A certain amount of fluid is reabsorbed by the brain but the remaining CSF will travel through the ventricular system to the fourth ventricle at the base of the brain where it will exit.

In neurosurgery, it is not uncommon to see a disruption to the balance between the amount of CSF that is produced and the amount that is reabsorbed. There are many things that can upset this balance, such as blood clots, tumours or scar tissue. This disruption can lead to a backup in the drainage system and lead to increased fluid around the brain resulting in increased pressure.

Think about a sink with a slow-flowing tap and the drainage pipe – if the drainage pipe is clogged up, water will either drain out very slowly or not at all. Since the tap continues to run water, the sink will slowly fill up. Unlike the sink that will just overflow, the brain is contained and the fluid has no way to be released. Therefore, pressure in the brain will occur.

When the ventricular system gets backed up in children, they can develop increased intracranial pressure. Some of the symptoms of increased pressure in the brain are:

  • In babies:
    • Abnormal increase in head circumference (size of head)
    • Full fontanelle (soft spot on top of baby head is bulging)
    • Split sutures (a gap that can be felt between the skull bones)
    • “Sunsetting” eyes (downward casting of eyes)
    • Poor feeding
    • Irritability
  • In children:
    • Headaches
    • Nausea and vomiting
    • Lethargy (wanting to sleep all the time and lack of energy)
    • Uncoordinated walking or lack of balance
    • Visual changes
    • Problems remembering

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