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MANAGEMENT OF HYDROCEPHALUS

The best line of treatment of hydrocephalus is to remove the cause of disease, such as fulguration of choroid plexus papilloma or removal of post fossa tumor.

This is not possible in the majority of cases i.e. we can not correct congenital malformation or remove glioma from brain stem, so in these cases we divert CSF pathway to overcome site of obstruction by using shunt ( fig. 7 & 8 ).

FIGURE 7 & 8: SHUNTING IN HYDROCEPHALUS

MANAGEMENT OF HYDROCEPHALUS (CONT.)

Shunt is still the most common method used to treat hydrocephalus. This is done by implanting a tube in the lateral ventricle and the distal end of the tube is put in the right atrium of the heart through internal jugular vein (V–A shunt), or pass subcutaneously in front of the chest wall to be implanted in the peritoneal cavity (V–P shunt).

MANAGEMENT OF HYDROCEPHALUS (CONT.)Recently with advancement of

endoscopic surgery we can use special neuro endoscope to create an opening in the floor of third ventricle to bypass obstructed Aqueduct and allow CSF to pass from Lateral ventricles to the third ventricle and then to the subarachnoid space.

This is called Endoscopic Third Ventriculostomy ( ETV ), this method is a new method, needs special training and equipment and it is not suitable for all cases.

MANAGEMENT OF HYDROCEPHALUS (CONT.)Although shunt is the commonest method

for treatment it has some disadvantages:

Shunt system is expensive. It is a foreign body, so during implantation if exposed

to contamination, this may lead to meningitis or encephalitis which may be lethal and in such cases shunt should be removed.

It is a narrow tube, so it is liable for obstruction (either proximal or distal end).

It may over drain the CSF so devices must be selected properly according to the estimated intra-ventricular pressure of the patients.

MANAGEMENT OF HYDROCEPHALUS (CONT.)Medical treatment have no role in the

management of hydrocephalus, so using carbonic anhydrase inhibitor ( Diamox ), will decrease the rate of secretion of CSF to some extent, but does not relief the obstruction so medical treatment may be used in doubtful cases or if there is contraindication for surgery such as bronchopneumonia or infection at the site of operation.

QUESTIONS?

Learn more about Spina Bifida and hydrocephalus at http://www.spinabifida.net