David F. Jimenez, M.D., FACS, professor and chair of neurosurgery at the UT Health Science Center San Antonio, is treating Baby Klaus, who has a severe case of hydrocephalus, a condition commonly known as “water on the brain.”
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Contact: Will Sansom, 210-567-2579

SAN ANTONIO ( Nov. 24, 2010 ) — David F. Jimenez, M.D., FACS, professor and chair 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.

Landmark case
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
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.

Stabilizing Baby Klaus
A shunt was not immediately an option for Baby Klaus, who turned 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. “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.”

Speaking about Baby Klaus’ case at University Hospital on Nov. 24 are (left to right) David F. Jimenez, M.D., chair of neurosurgery; Sheri Burdine, founder of Hydro Angels Over Texas; Klaus’ parents, Klaus Sr. and Beatrice; and Klaus’ aunt, Ericka. Last names of the family members are withheld at their request.

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 Over Texas.

He recently addressed the group and showed a video of endoscopic (camera-guided) treatment of the problem. The group put Dr. Jimenez in touch with the desperate parents of Baby Klaus and helped make it possible for them to make the long trip from West Texas to bring their son to Dr. Jimenez for treatment.

Surgery
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.

Dr. Jimenez began the surgical processes this week.

Baby Klaus’ parents, Klaus Sr. and Beatrice, have two older children. For months Klaus Sr. and Beatrice 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.”


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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 members 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.