Times of India
12 February, 2010
Umesh Isalkar
Pune, India

Despite being checked by several doctors in Saudi Arabia, Akbar Fazal Gul, 21, a resident of Medina, had been having severe headaches, giddiness and bouts of sleep disturbances for the last three years. A chance suggestion by a business associate rekindled hope for Gul.

Gul, along with his brother, Daud, approached the Deenanath Mangeshkar hospital here on March 2, 2009, in search of a solution. Doctors at the hospital diagnosed Gul with obstructive hydrocephalus – excessive accumulation of fluid in the brain. A relative ly new technique called endoscopic third ventriculostomy in which an endoscope (small elongated camera) is inserted inside the brain to clear obstruction came to his rescue. Gul calls the relief as ‘sakoon’.

Neurosurgeon Jaydev Panchawagh, who performed the surgery on Gul at the hospital on March 3, 2009, said, “A few years back, nobody could even imagine putting an endoscope inside the brain. I learnt the technique from professor Michael Gaab of Germany, who is a leading authority on the technique. I have been using the technique since 2001, and have developed it further”.

Endoscopes can now be passed through holes as small as 5 mm to 7 mm in the skull and then guide them to the ventricular system. An alternative pathway is made for the obstructed and bloated ventricular system to drain out the accumulated water or cerebrospinal fluid in the natural pathways by–passing the obstruction occurred due to narrowing of the vein – sylvian aqueduct – that passes it, said Panchawagh.

A visibly happy Gul said, “I feel normal and my headaches have disappeared and there is no feeling of giddiness or heaviness. “It was in Pune that I finally found a solution to my problem. Several doctors had advised me to undergo insertion of the shunt tube, which I did not want,” said Gul, who had come for a follow–up treatment at the hospital on February 9.

What is hydrocephalus?
The term hydrocephalus is derived from two words: ‘hydro’ meaning water and ‘cephalus’ referring to the head. Hydrocephalus is a condition in which excess cerebrospinal fluid builds up within the ventricles (fluid–containing cavities) of the brain and may increase pressure within the head. An obstructive hydrocephalus is a form of hydrocephalus which is caused by some visible blockage in the flow of cerebrospinal fluid.

Water in the brain:
Although hydrocephalus is often described as water in the brain, the water is actually cerebrospinal fluid, a clear fluid surrounding the brain and the spinal cord. Cerebrospinal fluid has three crucial functions:

1. It acts as a shock absorber for the brain and the spinal cord.
2. It acts as a vehicle for delivering nutrients to the brain and removing waste.
3. It flows between the cranium and the spine to regulate changes in pressure within the brain.

Symptoms of hydrocephalus in young and middle–age adults :
Headache, giddiness, difficulty in remaining awake or waking up; loss of co–ordination or balance, bladder control problems, impaired vision and cognitive skills that may affect job performance and personal skills.

Endoscopic third ventriculostomy:
This procedure is performed with an endoscope (elongated small camera), which is inserted into the third ventricle and a small perforation or hole is created allowing drainage of the cerebrospinal fluid from the blocked area into the normal cerebrospinal fluid space surrounding the brain. Endoscopic third ventriculostomy is recommended for certain cases of hydrocephalus, such as aqueductal stenosis (narrowing of the vein) that passes the cerebrospinal fluid, and is successful in 90 per cent of patients.

(Source: Department of neurosurgery, Deenanath Mangeshkar hospital, Pune)