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}};'''Associate Editor-In-Chief: {{SAH}} ''' [[User:zorkun|Cafer Zorkun]] M.D., PhD.,{{KD}}
==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.
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.
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{{#ev:youtube|bHD8zYImKqA}}
{{#ev:youtube|bHD8zYImKqA}}


* '''[[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
 
# [[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
The mainstay of treatment for hydrocephalus is medical therapy. Surgery is usually reserved for patients with either [[increased ICP]], [[stroke]] and [[subarachnoid hemorrhage]].
# [[shunt (medical)|ventriculo-atrial shunt]]:  Tube is placed in right atrium. It is done in cases with peritonitis or morbid obesity.
The feasibility of surgery depends on the stage of [[hydrocephalus]] at diagnosis.
# [[shunt (medical)|ventriculo-pleural shunt]]: Tube is placed in pleural cavity.
*The surgical methods of [[hydrocephalus]] are given below:
# [[gallbladder]]
*The [[decompressive crainectomy]] with [[shunting]] is the main surgical method use in hydrocephalus.
# [[Lumboperitoneal shunt]]:  shunt system can also be placed in the lumbar space of the spine and have the CSF redirected to the [[peritoneal cavity]]
*[[Shunting]]:It involves the placement of a [[catheter|ventricular catheter]].
* '''[[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]] is the tube made up 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
**[[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
**[[shunt (medical)|ventriculo-atrial shunt]]:  Tube is placed in right atrium.
**[[shunt (medical)|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 ===
=== 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 (medical)|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 ==
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[[Category:Neurological disorders]]
[[Category:Neurological disorders]]
[[Category:Greek loanwords]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Grammar]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]


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Revision as of 02:03, 13 August 2018

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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

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.

For a detailed approach on performing cerebral shunt watch the video below: {{#ev:youtube|bHD8zYImKqA}}


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.

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


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