Hydrocephalus surgery
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Hydrocephalus surgery On the Web |
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American Roentgen Ray Society Images of Hydrocephalus surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor-In-Chief: Cafer Zorkun M.D., PhD.,Kalsang Dolma, M.B.B.S.[2]
Overview
Surgery is the preferred treatment of hydrocephalus. Various shunt surgeries are done to bypass the cerebrospinal fluid flow obstruction and drain the excess fluid into other body cavities.
Surgery
Hydrocephalus treatment is surgical.
- Shunting:It involves the placement of a ventricular catheter (a tube made of silastic), into the cerebral ventricles to bypass the flow obstruction/malfunctioning arachnoidal granulations and drain the excess fluid into other body cavities, from where it can be resorbed.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. It is done in cases with peritonitis or morbid obesity.
- ventriculo-pleural shunt: Tube is placed in pleural cavity.
- gallbladder
- 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 : A surgically created opening in the floor of the third ventricle allows the CSF to flow directly to the basal cisterns, thereby shortcutting any obstruction, as in aqueductal stenosis. This may or may not be appropriate based on individual anatomy. Internal hydrocephalus can be successfully treated by placing a drainage tube (shunt) between the brain ventricles and abdominal cavity to eliminate the high internal pressures. There is some risk of infection being introduced into the brain through these shunts, however, and the shunts must be replaced as the person grows. A subarachnoid hemorrhage may block the return of CSF to the circulation. If CSF accumulates in the subarachnoid space, the condition is called external hydrocephalus. In this condition, pressure is applied to the brain externally, compressing neural tissues and causing brain damage. Thus resulting to a much further damage of the brain tissue and leading to necrotization
Shunt complications
Possible complications include
- Shunt malfunction
- Shunt failure
- Shunt infection
- When CSF drains more rapidly than it is produced by the choroid plexus, causing symptoms -
- Listlessness
- Severe headaches
- Irritability
- Light sensitivity
- Sound sensitivity
- Nausea
- Vomiting
- Dizziness
- vertigo
- Migraines
- Seizures
- A change in personality
- Weakness in the arms or legs
- Excessive head growth (seen infants, children under age 2)
- Strabismus
- Double vision- to appear when the patient is vertical. If the patient lies down, the symptoms usually vanish in a short amount of time.
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.