Hydrocephalus surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor-In-Chief: Syed Ahsan Hussain, M.D.[2] Cafer Zorkun M.D., PhD.,Kalsang Dolma, M.B.B.S.[3]
Overview
The mainstay of treatment for hydrocephalus is medical therapy. Surgery is usually reserved for patients with either increased ICP, stroke and subarachnoid hemorrhage. The surgical methods of hydrocephalus are Decompressive crainectomy with shunting is the main surgical method use in hydrocephalus. Shunting involves the placement of a ventricular catheter. Shunt is the tube placed in cerebral ventricles to bypass the flow of malfunctioning arachnoidal granulations. Shunt, drains out the excess fluid into other body cavities, which is resorbed from there.
Surgery
- The surgical treatment is given below:[1][2][3][4][5]
- Hydrocephalus treatment is surgical.
- For a detailed approach on performing cerebral shunt watch the video below:
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The mainstay of treatment for hydrocephalus is medical therapy. Surgery is usually reserved for patients with either increased ICP, stroke and subarachnoid hemorrhage.
The feasibility of surgery depends on the stage of hydrocephalus at diagnosis.
- The surgical methods of hydrocephalus are given below:
- The decompressive crainectomy with shunting is the main surgical method use in hydrocephalus.
- Shunting:It involves the placement of a ventricular catheter.
- Shunt is the tube placed in cerebral ventricles to bypass the flow of malfunctioning arachnoidal granulations.
- Shunt, drains out the excess fluid into other body cavities, which is resorbed from there.
- Types of shunts done are
- ventriculo-peritoneal shunt (most common): Tube is placed in peritoneal cavity.
- Long peritoneal catheter can be used so as to obviate the need to change the catheter as the child grows
- ventriculo-atrial shunt: Tube is placed in right atrium.
- ventriculo-pleural shunt: Tube is placed in pleural cavity.
- Lumboperitoneal shunt: shunt system can also be placed in the lumbar space of the spine and have the CSF redirected to the peritoneal cavity
- Endoscopic third ventriculostomy:
- The procedure of endoscopic ventriculostomy is given below:
- A surgically created opening in the floor of the third ventricle allows the CSF to flow directly to the basal cisterns.
- It removes the obstruction in aqueductal stenosis.
Shunt complications
Possible complications include
- Shunt malfunction
- Shunt failure
- Shunt infection
- When CSF drains more rapidly than it is produced by the choroid plexus it causes following symptoms:
- Severe headaches
- Irritability
- Light sensitivity
- Sound sensitivity
- Nausea
- Vomiting
- Dizziness
- Vertigo
- Migraines
- Seizures
- Personality changes
- Weakness in the arms or legs
- Excessive head growth (seen infants, children under age 2)
- Double vision.
- Resistance to traditional analgesic pharmacological therapy may also be sign of shunt overdrainage or failure.
- Diagnosis of the particular complication usually depends on when the symptoms appear.
References
- ↑ Burkert W, Paver HD (1988). "[Decompressive trepanation in therapy refractory brain edema]". Zentralbl. Neurochir. (in German). 49 (4): 318–23. PMID 3075392.
- ↑ Rinaldi A, Mangiola A, Anile C, Maira G, Amante P, Ferraresi A (1990). "Hemodynamic effects of decompressive craniectomy in cold induced brain oedema". Acta Neurochir Suppl (Wien). 51: 394–6. PMID 2089950.
- ↑ Gaab M, Knoblich OE, Fuhrmeister U, Pflughaupt KW, Dietrich K (1979). "Comparison of the effects of surgical decompression and resection of local edema in the therapy of experimental brain trauma. Investigation of ICP, EEG and cerebral metabolism in cats". Childs Brain. 5 (5): 484–98. PMID 477464.
- ↑ Dam Hieu P, Sizun J, Person H, Besson G (May 1996). "The place of decompressive surgery in the treatment of uncontrollable post-traumatic intracranial hypertension in children". Childs Nerv Syst. 12 (5): 270–5. PMID 8737804.
- ↑ Gower DJ, Lee KS, McWhorter JM (October 1988). "Role of subtemporal decompression in severe closed head injury". Neurosurgery. 23 (4): 417–22. PMID 3200370.