Hydrocephalus surgery: Difference between revisions

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{{Hydrocephalus}}
{{Hydrocephalus}}
{{CMG}};'''Associate Editor-In-Chief:''' [[User:zorkun|Cafer Zorkun]] M.D., PhD.,{{KD}}
{{CMG}}; {{AE}} {{SAH}}
==Overview==
==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.
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 [[catheter|ventricular catheter]]. [[Shunt]] is the tube placed in [[ventricle (brain)|cerebral ventricles]] to bypass the flow of malfunctioning [[arachnoid villi|arachnoidal granulations]]. [[Shunt]], [[Drain (surgery)|drains]] out the excess fluid into other body cavities, which is resorbed from there.
==Surgery==
==Surgery==
Hydrocephalus treatment is surgical.
*The surgical treatment is given below:<ref name="pmid3075392">{{cite journal |vauthors=Burkert W, Paver HD |title=[Decompressive trepanation in therapy refractory brain edema] |language=German |journal=Zentralbl. Neurochir. |volume=49 |issue=4 |pages=318–23 |date=1988 |pmid=3075392 |doi= |url=}}</ref><ref name="pmid2089950">{{cite journal |vauthors=Rinaldi A, Mangiola A, Anile C, Maira G, Amante P, Ferraresi A |title=Hemodynamic effects of decompressive craniectomy in cold induced brain oedema |journal=Acta Neurochir Suppl (Wien) |volume=51 |issue= |pages=394–6 |date=1990 |pmid=2089950 |doi= |url=}}</ref><ref name="pmid477464">{{cite journal |vauthors=Gaab M, Knoblich OE, Fuhrmeister U, Pflughaupt KW, Dietrich K |title=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 |journal=Childs Brain |volume=5 |issue=5 |pages=484–98 |date=1979 |pmid=477464 |doi= |url=}}</ref><ref name="pmid8737804">{{cite journal |vauthors=Dam Hieu P, Sizun J, Person H, Besson G |title=The place of decompressive surgery in the treatment of uncontrollable post-traumatic intracranial hypertension in children |journal=Childs Nerv Syst |volume=12 |issue=5 |pages=270–5 |date=May 1996 |pmid=8737804 |doi= |url=}}</ref><ref name="pmid3200370">{{cite journal |vauthors=Gower DJ, Lee KS, McWhorter JM |title=Role of subtemporal decompression in severe closed head injury |journal=Neurosurgery |volume=23 |issue=4 |pages=417–22 |date=October 1988 |pmid=3200370 |doi= |url=}}</ref>
* '''[[Shunting]]''':It involves the placement of a [[catheter|ventricular catheter]] (a tube made of [[silastic]]), into the [[ventricle (brain)|cerebral ventricles]] to bypass the flow obstruction/malfunctioning [[arachnoid villi|arachnoidal granulations]] and drain the excess fluid into other body cavities, from where it can be resorbed.Types of shunts done are
*Hydrocephalus treatment is surgical.
# [[shunt (medical)|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
*For a detailed approach on performing cerebral shunt watch the video below:
# [[shunt (medical)|ventriculo-atrial shunt]]:  Tube is placed in right atrium. It is done in cases with peritonitis or morbid obesity.
{{#ev:youtube|bHD8zYImKqA}}
# [[shunt (medical)|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]]
*The mainstay of treatment for hydrocephalus is medical therapy.
* '''[[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
*Surgerical option is for patients with either [[increased ICP]], [[stroke]] and [[subarachnoid hemorrhage]].
*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.
**[[Shunt]]: Shunting needs the placement of a [[catheter|ventricular catheter]].
**[[Shunt]] is the tube placed in [[ventricle (brain)|cerebral ventricles]] to bypass the flow of malfunctioning [[arachnoid villi|arachnoidal granulations]].
**[[Shunt]], [[drain (surgery)|drains]] out the excess fluid into other body cavities, which is reasorbed from there.
*Types of shunts are:
**[[shunt (medical)|ventriculo-peritoneal shunt]].
**[[shunt (medical)|ventriculo-atrial shunt]].
**[[shunt (medical)|ventriculo-pleural shunt]].
**[[Shunts|Lumboperitoneal shunt]].
**[[Endoscopic third ventriculostomy]].


=== Shunt complications ===
=== Shunt complications ===
Possible complications include
Possible complications include
* Shunt malfunction
*Shunt malfunction
* Shunt failure
*Shunt failure
* Shunt infection
*Shunt infection
* When CSF drains more rapidly than it is produced by the [[choroid plexus]], causing symptoms -
*When CSF drains more rapidly than it is produced by the [[choroid plexus]] it causes following symptoms:
* Listlessness
**Severe [[headaches]]
# Severe [[headaches]]
**[[Irritability]]
# [[Irritability]]
**[[Light sensitivity]]
# [[Light sensitivity]]
**[[Sound sensitivity]]
# [[Sound sensitivity]]
**[[Nausea]]
# [[Nausea]]
**[[Vomiting]]
# [[Vomiting]]
**[[Dizziness]]
# [[Dizziness]]
**[[Vertigo case study one|Vertigo]]
# [[Vertigo (medical)|vertigo]]
**[[Migraines]]
# [[Migraines]]
**[[Seizures]]
# [[Seizures]]
**Personality changes
# A change in personality
**[[Weakness]] in the arms or legs
# [[Weakness]] in the arms or legs
**Excessive head growth (seen infants, children under age 2)
# Excessive head growth (seen infants, children under age 2)
**[[Double vision]].
# [[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.


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 ==
== References ==
{{reflist|2}}
{{reflist|2}}


[[Category:Neurological disorders]]
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[[Category:Disease]]
[[Category:Neurology]]
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[[Category:Pediatrics]]
[[Category:Pediatrics]]


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Latest revision as of 01:36, 23 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Ahsan Hussain, M.D.[2]

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:

{{#ev:youtube|bHD8zYImKqA}}


Shunt complications

Possible complications include

  • 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

  1. ↑ Burkert W, Paver HD (1988). "[Decompressive trepanation in therapy refractory brain edema]". Zentralbl. Neurochir. (in German). 49 (4): 318–23. PMID 3075392.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ Gower DJ, Lee KS, McWhorter JM (October 1988). "Role of subtemporal decompression in severe closed head injury". Neurosurgery. 23 (4): 417–22. PMID 3200370.


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