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Surgery - Hydrocephalus
Introduction
the cerebral ventricular system's enlargement. Subdivided into communicating and non-communicating (or obstructive and non-obstructive). The phrase "hydrocephalus ex vacuo" refers to an apparent enlargement of the ventricles, however this is actually a compensatory alteration brought on by brain shrinkage.
Etiology
One of the following factors may contribute to abnormal CSF buildup in the ventricles:1. obstructed, or poor, outflow of CSF from the ventricular system
3. poor CSF resorption in the subarachnoid villi (non-obstructive); 4. lesions of the fourth, third, and cerebral aqueduct; 5. posterior fossa lesions (such as tumors, blood) compressing the fourth ventricle; 6. cerebral aqueduct stenosis
tumors,
-normal pressure hydrocephalus (NPH), an idiopathic persistent ventricular enlargement; -meningitis (usually tuberculosis). The impairment of gait and cognitive decline is brought on by injury to the long white matter tracts (corona radiata, anterior commissure).
Epidemiology
age distribution that is bimodal. strokes and tumors in the elderly, congenital abnormalities and tumors in the young.
History
Acute reduction in consciousness is known as obstructive hydrocephalus. Diplopia.
NPH: Incontinence of the urine, falls, and chronic cognitive deterioration.
Obstructive hydrocephalus: Examination I impaired GCS, palsy of the VI nerve (a "false localizing sign" of elevated ICP), and papilloedema. Neonates may have a "sunset sign" (a downward conjugate deviation of the eyes) and an enlarged head circumference.
NPH: Impairment of cognition. Apraxia of gait (shuffling). Overreaction.
Investigations
Head of CT: primary research to identify hydrocephalus. may also identify the root cause, such as a brainstem tumor.
Lumbar puncture: Due to the risk of tonsillar herniation and mortality, this procedure is not recommended in patients with obstructive hydrocephalus. may be required as a treatment trial in patients with normal pressure hydrocephalus.
CSF: Drawn from lumbar punctures or ventricular drains, which may reveal an underlying pathology (such as tuberculosis). Examine for protein, glucose (both CSF and plasma), and MC&S.
Management
Airway, breathing, and circulation in an emergency. Keep the airway safe and secure if GCS is compromised.
Address seizures. Get a CT scan and contact neurosurgery right away.
External ventricular drain: To get around any blockage, a catheter is inserted into the lateral ventricle.
A ventricular catheter is inserted into one or both lateral ventricles and connected to a subcutaneous drain that travels to the peritoneal cavity in a procedure known as ventriculoperitoneal shunting. carries a risk of blockage, infection, or malfunction (particularly with electronic shunts).
A different technique that might be useful for communicating hydrocephalus is lumbroperitoneal shunting.
Advanced neurosurgery: Other methods for avoiding obstructions or preserving patency for CSF flow include aqueductoplasty and endoscopic ventriculostomy.
Complication
brain death,brain coning, and herniation.
Prognosis
If left untreated, obstructive hydrocephalus can be fatal. Shunting can help NPH patients with their declining cognitive and gait.
Introduction
the cerebral ventricular system's enlargement. Subdivided into communicating and non-communicating (or obstructive and non-obstructive). The phrase "hydrocephalus ex vacuo" refers to an apparent enlargement of the ventricles, however this is actually a compensatory alteration brought on by brain shrinkage.
Etiology
One of the following factors may contribute to abnormal CSF buildup in the ventricles:1. obstructed, or poor, outflow of CSF from the ventricular system
3. poor CSF resorption in the subarachnoid villi (non-obstructive); 4. lesions of the fourth, third, and cerebral aqueduct; 5. posterior fossa lesions (such as tumors, blood) compressing the fourth ventricle; 6. cerebral aqueduct stenosis
tumors,
-normal pressure hydrocephalus (NPH), an idiopathic persistent ventricular enlargement; -meningitis (usually tuberculosis). The impairment of gait and cognitive decline is brought on by injury to the long white matter tracts (corona radiata, anterior commissure).
Epidemiology
age distribution that is bimodal. strokes and tumors in the elderly, congenital abnormalities and tumors in the young.
History
Acute reduction in consciousness is known as obstructive hydrocephalus. Diplopia.
NPH: Incontinence of the urine, falls, and chronic cognitive deterioration.
Obstructive hydrocephalus: Examination I impaired GCS, palsy of the VI nerve (a "false localizing sign" of elevated ICP), and papilloedema. Neonates may have a "sunset sign" (a downward conjugate deviation of the eyes) and an enlarged head circumference.
NPH: Impairment of cognition. Apraxia of gait (shuffling). Overreaction.
Investigations
Head of CT: primary research to identify hydrocephalus. may also identify the root cause, such as a brainstem tumor.
Lumbar puncture: Due to the risk of tonsillar herniation and mortality, this procedure is not recommended in patients with obstructive hydrocephalus. may be required as a treatment trial in patients with normal pressure hydrocephalus.
CSF: Drawn from lumbar punctures or ventricular drains, which may reveal an underlying pathology (such as tuberculosis). Examine for protein, glucose (both CSF and plasma), and MC&S.
Management
Airway, breathing, and circulation in an emergency. Keep the airway safe and secure if GCS is compromised.
Address seizures. Get a CT scan and contact neurosurgery right away.
External ventricular drain: To get around any blockage, a catheter is inserted into the lateral ventricle.
A ventricular catheter is inserted into one or both lateral ventricles and connected to a subcutaneous drain that travels to the peritoneal cavity in a procedure known as ventriculoperitoneal shunting. carries a risk of blockage, infection, or malfunction (particularly with electronic shunts).
A different technique that might be useful for communicating hydrocephalus is lumbroperitoneal shunting.
Advanced neurosurgery: Other methods for avoiding obstructions or preserving patency for CSF flow include aqueductoplasty and endoscopic ventriculostomy.
Complication
brain death,brain coning, and herniation.
Prognosis
If left untreated, obstructive hydrocephalus can be fatal. Shunting can help NPH patients with their declining cognitive and gait.
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