SAN ANTONIO (Nov. 24, 2010) — David F. Jimenez, M.D., FACS, professor and chairman of neurosurgery at the UT Health Science Center San Antonio, has treated at least 1,000 children with hydrocephalus, a condition best known to the public as “water on the brain.” In some of those cases, the baby’s head circumference was 25 percent larger than normal.
But when a baby from West Texas named Klaus was brought to his pediatric clinic at University Hospital on Nov. 17, Dr. Jimenez knew he had seen the most severe case of hydrocephalus in his 25-year career. Baby Klaus’ head circumference measured 104 centimeters, nearly 3½ feet around. A normal circumference at 11 months of age is 45 centimeters, or a foot and a half. Klaus’ head was a staggering 131 percent above normal size.
“His parents have done an unbelievable job caring for him at home and getting him this far in life,” Dr. Jimenez said. “They were told he was going to die, but he didn’t. He has the body of about a 2-month-old because his brain is using up the resources, but he responds to auditory stimuli, he cries, and he quiets when we return. He loves to have his forehead massaged. All the nurses are fighting to take care of him. He is our VIP now.”
Hydrocephalus is marked by an abnormal rise in cerebrospinal fluid volume and pressure. This protective fluid, produced deep inside the brain from blood, normally surrounds the brain and spinal cord. To maintain a balance, specialized cells absorb the fluid and circulate it to the heart, which pumps it back to the brain. “It looks like pure, distilled water,” Dr. Jimenez said. “Our bodies make approximately half a liter of it a day.”
Hydrocephalus is caused by infections, cysts, tumors, hemorrhages and congenital anomalies. In babies, it is treated immediately after birth with a shunt to relieve the volume and pressure. A tube is placed into the brain where the fluid is produced. The tube is routed behind the ear, down the neck to the chest and into the abdominal cavity, where the intestines reabsorb the fluid and send it back to the heart. Like plumbing, shunts must periodically be replaced.
A shunt is not yet an option for Baby Klaus, who will turn 11 months old on Thanksgiving Day. Relieving the volume and pressure too quickly could kill the child by causing a stroke. Instead, Dr. Jimenez installed a drain in the back of the head for controlled release of the fluid. The circumference is already nearly a foot smaller. “We are getting him to homeostasis or internal stability,” Dr. Jimenez said. “The baby is used to a certain pressure. If we bring it down quickly, the brain would collapse. We must slowly let the brain and head adjust to the new pressure.”
Dr. Jimenez is the only board-certified pediatric neurosurgeon in San Antonio and one of only 200 in the country. As part of UT Medicine San Antonio, the faculty practice of the Health Science Center School of Medicine, he has pioneered the minimally invasive surgical treatment of craniosynostosis, an elongated head shape in infants. Therefore it was not surprising when he was asked recently to speak to a hydrocephalus support group in San Antonio called Hydro Angels. On a Friday evening, he addressed the group and showed a video of endoscopic (camera-guided) treatment of the problem. Soon group members put him in touch with the desperate parents of Baby Klaus. They made a long trip from West Texas to bring their son.
Hydrocephalus occurs in fewer than 1 in 500 live births but is “probably the most common congenital problem we see,” Dr. Jimenez said. Baby Klaus will require extensive surgery to reduce the size of the cranial bones, which are thin and stretched. In addition, he may suffer significant vision impairment but it is too soon to know that, Dr. Jimenez said.
Baby Klaus’ parents, Klaus Sr. and Beatrice, have two older children. For months they were told nothing could be done. A therapist who visited the family began pushing for action. A caller reached Hydro Angels shortly after Dr. Jimenez’s lecture to the group and soon an appointment was scheduled. It is a prime example of the School of Medicine reaching out to the community.
“The parents are really nice people and love their baby,” Dr. Jimenez said. “This situation shows that we must educate people, medical professionals and parents alike, to stop hydrocephalus early, because there is effective treatment.”
UT Medicine San Antonio is the clinical practice of the School of Medicine at the UT Health Science Center at San Antonio. With more than 700 doctors – all faculty from the School of Medicine – UT Medicine is the largest medical practice in Central and South Texas, with expertise in more than 60 different branches of medicine. Primary care doctors and specialists see patients in private practice at UT Medicine’s clinical home, the Medical Arts & Research Center (MARC), located in the South Texas Medical Center at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and there are clinics and physicians at several local and regional hospitals, including CHRISTUS Santa Rosa, University Hospital and Baptist Medical Center. Call (210) 450-9000 to schedule an appointment, or visit the Web site at www.UTMedicine.org for a complete listing of clinics and phone numbers.
About University Health System
University Health System, the public hospital district for Bexar County, Texas, is the lead trauma center for South Texas. In 2010, University Health System was named one of the 100 Most Wired Hospitals and Health Systems by the American Hospital Association and Hospitals & Health Networks magazine and was included among Health Imaging Magazine’s Top 25 Most Connected Healthcare Facilities. University Health System is also the first and only healthcare organization in South Texas to achieve Magnet status by the American Nursing Credentialing Center (ANCC) and San Antonio’s only health system to be ranked as a Top 50 Hospital by U.S. News & World Report.
University Hospital, a 498-bed acute care hospital, is the primary teaching hospital for the UT Health Science Center San Antonio and the only trauma center in South Texas equipped to provide lifesaving care to seriously injured children, including severe burn injuries. University Health System also includes 16 community clinics focused on primary, specialty, preventive health services.