Hydrocephalus is a condition in which excessive cerebrospinal fluid buildup in the brain causes increased pressure in the head. Brain fluids in normal amounts to keep the brain healthy but in excess amounts can be harmful
Causes of Hydrocephalus
Hydrocephalus is caused by two things: Hydrocephalus is caused by an imbalance between the amount of cerebrospinal fluid produced and the amount of fluid absorbed by the bloodstream, and the fluid pathways allow to be blocked or narrowed, resulting in fluid it can not flow properly. Common causes are usually tumor, infection or bleeding
Symptoms that are felt include headaches, weakness, and vomiting. In infants the size of a head can become larger than a child his age. Older patients usually experience balance problems, difficulty walking, difficulty remembering short-term memory, and can not control urination
Hydrocephalus is diagnosed by radiological examination such as CT scan or MRI. This examination can determine the cause of hydrocephalus
Hydrocephalus to date can only be treated with surgery Two common surgical techniques are performed:
- Shunt operation. Shunt is a small tube that will drain brain fluid to other body parts to be absorbed
- Endoscopic third ventriculostomy (ETV) is the manufacture of a hole in the third ventricle using an endoscope. This procedure allows obstructed brain fluids to be recirculated and well absorbed
Shunts can be attached from the ventricle of the brain and drained to one of several places in the body. Your surgeon will decide the best location
- Ventriculo-peritoneal (VP) Shunt – The cerebrospinal fluid will be absorbed into the abdominal cavity where it is brought back into the bloodstream.
- Ventriculo-atrial (VA) Shunt – The cerebrospinal fluid will be absorbed directly into one of the blood vessels leading to the heart.
- Ventriculo-pelural (V-Pleural) shunt – The cerebrospinal fluid will be absorbed into the space next to the lung where it is brought back into the bloodstream.
Shunt Installation Procedures
Incorporating a ventricular shunt, the patient needs to be totally boiled (the drug given to make the patient fall asleep), and will follow the following steps:
- Usually will be formed two pieces on the skin, first in the head usually above and on the side of the ear. The second piece of cutting is done in the abdomen (VP Shunt), on the side of the neck (VA Shunt), or on the chest (V-pleural shunt).
- A hole is made through the skull and a tube is inserted into the ventricle.
- A tunnel is then constructed to insert a shunt tool under the skin between the two pieces to be connected to the ventricle tube, then the opened skin is closed again. The operation lasts between 1 and 2 hours
2. Endoscopic Third Ventriculostomy (ETV)
In some cases fluid hydrocephalus in the brain may be blocked, may also be caused by congenital origin, a result of a tumor, or a result of several other factors. If that happens, then it is possible to create a new pathway for cerebrospinal fluid (ventriculostomy), this action called the “Endoscopic Third Ventriculostomy (ETV)” act by creating a new path for cerebrospinal fluid flow. This is done using a special telescope tube called neuro-endoscopy that neurosurgeons use to see in the ventricles in the brain.
The advantage of this surgery is permanent healing. Shunts can fail over time and need to be replaced. The decision on whether this operation is possible by a neurosurgeon after a scan. It is important to clarify that this operation of action makes it impossible to produce good results once the shunt action is still in need.
ETV Action Stages
ETV surgery requires total anesthesia, and is followed by the following steps:
- Cutouts are made at 2-3cm, usually at the top of the head toward the front and next to the hairline. Usually on the most right side but can also be on the left side, depending on the scan findings.
- The skull bone is then perforated at 1-1.5 cm
- A neuroendoscope tool is inserted to create a hole.
- Finally, the neurosurgeon ensures that the ventriculostomy is fully exposed before removing the endoscope and completing the operation.
Risk of ETV Procedures
Both of these surgical procedures allow for the occurrence of complications after surgery. The shunt system may stop draining the cerebrospinal fluid or regulate drainage poorly due to mechanical damage, blockage, or infection. Complications of ventriculostomy include bleeding and infection.
Other failures that require immediate attention such as re-operations or other interventions. Signs and symptoms of the problem include:
- Easy to get angry
- Nausea and vomiting
- Vision issues
- Redness, pain or tenderness on the skin along the shunt tube line
- Abdominal pain when the shunt valve is in the stomach
- Recurrence of any of the initial symptoms felt
After surgery for Hydrocephalus
After surgery, then you will be treated in the Hospital for several days during the recovery period. You will be sleepy for several hours, you will also feel the pain after surgery and the pain can be treated with painkillers. You may also experience headaches due to pressure changes on your head.
The length of stay in the hospital also depends on the cause of the hydrocephalus. For the most part, these actions are meant for life although revisions will still be needed from time to time.
After Leaving Hospital
- Little by little you can return to normal activity
- You can take anti-pain medication if you feel pain at any time according to the instructions described by the doctor
- You are allowed to shampoo with a soft shampoo
- Reduce severe exercise for six months
Some signs and symptoms if the shunt infects:
- Feeling unwell
- Higher body temperature
- Neck stiff
- Mta sick
- CSF leak (Brain fluid) from wound
- Swollen or damaged surgery