The singer Chico Buarque had to undergo neurological surgery on Tuesday (3) to treat normal-pressure hydrocephalus, or hydrocephalus with normal pressure. The condition occurs when there is an excess of CSF – the fluid that surrounds the central nervous system – accumulated in the brain, but without causing an increase in intracranial pressure. Even so, hydrocephalus can impact leg movements, cognition, and urinary control capacity.
The fluid drainage was performed through a ventriculoperitoneal shunt, a procedure that involves implanting a valve capable of draining the excess fluid produced in the brain to the abdominal cavity. Buarque was diagnosed early during a check-up and is already recovering in his room, “with his usual good humor,” according to his press office. The expectation is that he will be discharged in 48 hours.
Neurosurgeon Fernando Gomes, professor at the Hospital das Clínicas of the University of São Paulo School of Medicine, explains that this is a surgery of intermediate complexity, but it allows the patient to recover the impaired functions as soon as the drainage normalizes. Currently, programmable valves are used, including national technology, which allow adjustment of the amount drained even after implantation, if necessary.
If the condition is not diagnosed and treated in time, the consequences can be drastic. “The person can become completely unable to walk, progress to a serious dementia condition, and urinary and fecal incontinence. It’s a quite complicated condition. The person doesn’t die directly from normal-pressure hydrocephalus, but has their life shortened by issues that come along with this worsening of health conditions,” says the specialist.
Gomes also coordinates the Cerebral Hydrodynamics Group at the Hospital das Clínicas and warns that this condition is more common in people over 60 years old, which can make disease identification difficult. According to him, it is estimated that 480,000 people have normal-pressure hydrocephalus in Brazil.
“Often, we make the diagnosis and when looking back, the patient already had a clinical picture. Because at the beginning it can be somewhat confused with the aging process, a certain difficulty walking. Sometimes, the person had prostate surgery and has urinary incontinence or another associated disease, like Alzheimer’s, which impacts cognition, and then it takes longer to make the diagnosis,” adds the neurosurgeon.
Symptoms
Grupo Valsa Saúde neurologist Lucas Savelli, who is also a full member of the Brazilian Academy of Neurology, warns that hydrocephalus symptoms often go unnoticed in the aging context. Therefore, any reduction in cognitive or motor capacity should be evaluated by a specialist.
He highlights that a very characteristic symptom of normal-pressure hydrocephalus is the so-called “magnetic gait,” when the patient “has some difficulty, so to speak, lifting their feet off the ground to walk.” Urinary incontinence and cognitive decline are also common symptoms, but these three situations do not always appear together.
“The main suspicion is clinical, through the symptoms. But we confirm with imaging exams, preferably brain MRI, which shows this region where the CSF is present with increased size. It is also important to perform an exam called TAP test, in which a needle is inserted in a region near the spine to withdraw a quantity of fluid. After that, it is assessed whether there was improvement in cognitive tests, indicating an accumulation causing this decline,” adds Savelli.
Neurosurgeon Fernando Gomes adds that many cases of normal-pressure hydrocephalus are idiopathic, that is, without a known origin, but there are secondary cases, when hydrocephalus arises as a consequence of another problem: “The patient had, for example, a skull trauma with some bleeding; this blood contacts the CSF and hinders drainage. Or meningitis, even if viral, can also hinder drainage later as a sequela. There are also people who underwent some other neurosurgery, and as an organ response, there is fluid accumulation.”
After a condition like this, it is even more important not to ignore the classic hydrocephalus symptoms.
“The surgical procedure has a good prognosis and functions can be restored. But this evolution ends up being ineffective if you don’t act in time,” highlights the doctor.
Source: Agência Brasil