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Hydrocephalus

Hydrocephalus

Hydrocephalus is a condition in which cerebrospinal fluid (brain fluid) increases in the brain. This brain fluid is necessary to provide protection for the brain, as the fluid in the uterus protects the growing baby. The brain makes cerebrospinal fluid in a special fluid chamber called a ventricle. This fluid flows through the ventricles and around the brain and is then absorbed back into the body. Hydrocephalus occurs when a blockage prevents excessive cerebrospinal fluid from drying.

What Causes of Hydrocephalus?

Hydrocephalus is caused by two things, namely:

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 inhibited or narrowed, so that the fluid can not flow properly. Usually the cause of the inhibition of the fluid is caused by a tumor.

What are the Symptoms?

Symptoms that are felt include headaches, weakness, and vomiting. Older patients usually experience balance problems, difficulty walking, difficulty remembering short-term memory, and can not control urination

Check What’s Needed?

  • CT-scan

In general, a CT scan will show signs. This check is done to be able to know what action should be done.

  • MRI Scan

MRI Scan is a further examination that uses MRI to know more detailed results.

What are the Treatment Options?

The neurosurgeon will recommend treatment based on the cause of hydrocephalus and other factors as found in the scan examination. All treatments are performed to lower the pressure inside the head, either by diverting the flow of brain fluid or by restoring normal flow.

Two main treatment methods:

  • Insert a “shunt” (tool for releasing pressure in the brain)
  • Endoscopic third ventriculostomy (ETV) is the manufacture of a hole in the third ventricle using an endoscope. This procedure allows obstructed brain fluids to reach the subarachnoid spatium immediately so that the flow of fluid becomes more fluid.
  1. Shunt

Shunt is a small tube that is permanently planted that can allow excess fluid to flow to other absorbable body parts. Depending on the cause of hydrocephalus, the fluid can be dried from the ventricle of the brain (ventricular disk) or from around the spinal cord in the lower back (lumbar shunt).

  • Ventricular Shunt

There are three types of ventrucular shunt used:

  • 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.

How is Ventricular Shunt installed?

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. </ li>
  • A tunnel is then created 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.
  • Lumbar Shunts

Lumbar shunt requires a tube dryer of cerebrospinal fluid from around the spinal cord in the lower back.

  • Lumbo-peritoneal (LP) Shunt – The cerebrospinal fluid will be absorbed into the abdominal cavity where it is brought back into the bloodstream.

How is Lumbar Shunt installed?

Incorporating lumbar shunt also requires total anesthesia, and is followed by several steps as follows:

  • Usually there will be two pieces on the spine, and the second is in the abdomen (LP shunt), or the chest (L-pleural shunt).
  • Lumbar puncture (spinal tap) is done through the opened skin area at the back. </ li>
  • The shunt tube is then passed through the needle into the space around the spine. </ li>
  • A tunnel is then created to insert a shunt tool under the skin between the two pieces which, then the opened skin is closed again.
  1. Endoscopic Third Ventriculostomy(ETV)

In some cases fluid hydrocephalus in the brain may be blocked, may also be caused by 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 is called

The action “Endoscopic Third Ventriculostomy (ETV)” is an action by creating a new pathway 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.

What are the Advantages of this Operation?

The advantage of this surgery is permanent healing. Shunts can fail over time and need to be replaced. The decision on whether the operation is possible by a neurosurgeon after a scan. It is important to clarify that the operation of the action shunt action is still in need.

What is the stage of the operation?

Incorporating lumbar shunt also requires total anesthesia, and is followed by several steps as follows:

  • Usually there will be two pieces on the spine, and the second is in the abdomen (LP shunt), or the chest (L-pleural shunt).
  • Lumbar puncture (spinal tap) is done through the opened skin area at the back.
  • The shunt tube is then passed through the needle into the space around the spine.
  • A tunnel is then created to insert a shunt tool under the skin between the two pieces which, then the opened skin is closed again.
  1. Endoscopic Third Ventriculostomy (ETV)

In some cases fluid hydrocephalus in the brain may be blocked, may also be caused by 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 is called

The action “Endoscopic Third Ventriculostomy (ETV)” is an action by creating a new pathway 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.

What are the Advantages of this Operation?

The advantage of this surgery is permanent healing. Shunts can fail over time and need to be replaced. The decision on whether the operation is possible by a neurosurgeon after a scan. It is important to clarify that the operation of the action shunt action is still in need.

What is the stage of the operation?

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 towards the front and next to the hairline. Usually on the most right side 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.

What will happen after surgery?

Patients stay in the hospital 2 to 3 days. When the swelling after shunt installation is lost, the shunt is usually not visible. Spinal headache is caused by a leak of brain fluid (CFS) around the catheter or shunt area. Lie flat and drink plenty of caffeinated noncarbonate liquids such as tea and coffee.

The patient should be relaxed a few weeks after surgery, without bending, twisting, lifting weight, or wearing a matching hat. The incision takes time to heal. Patients may bathe as instructed by their surgeon but should not bathe in the bath or swim for 4 weeks. The incision should be patted dry with a soft towel to avoid irritation.

Contact the surgeon if the patient’s temperature exceeds 38 ° C or if the incision starts showing signs of infection, such as redness, swelling, pain, or drainage.

If the patient has severe headache, vomiting, and a stiff neck that prevents lower chin to the chest – this is an emergency – go to the hospital. These are signs of bleeding in the brain.

What is the Risk of this Treatment?

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 as re-operations or other interventions. Signs and symptoms of the problem include:

  • Fever
  • Easy to get angry
  • Sleepy
  • Nausea and vomiting
  • Headaches
  • 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

Source:

https://www.mayoclinic.org/diseases-conditions/hydrocephalus/basics / treatment / con-20030706

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