5methods of hydrocephalustreatmentLearnmoreaboutSpi naBi f i daatht t p: //www. spi nabi f i da. net
Management of HydrocephalusThe best line of treatment of hydrocephalus is toremove the cause of disease, such asfulguration of choroid plexus papilloma orremoval of post fossa tumor.This is not possible in the majority of cases i.e. wecan not correct congenital malformation orremove glioma from brain stem, so in thesecases we divert CSF pathway to overcome siteof obstruction by using shunt ( fig. 7 & 8 ).
Management of Hydrocephalus (Cont.)Shunt is still the most common methodused to treat hydrocephalus. This isdone by implanting a tube in the lateralventricle and the distal end of the tubeis put in the right atrium of the heartthrough internal jugular vein (V–Ashunt), or pass subcutaneously infront of the chest wall to be implantedin the peritoneal cavity (V–P shunt).
Management of Hydrocephalus (Cont.)Recently with advancement ofendoscopic surgery we can use specialneuro endoscope to create an openingin the floor of third ventricle to bypassobstructed Aqueduct and allow CSF topass from Lateral ventricles to thethird ventricle and then to thesubarachnoid space.This is called Endoscopic ThirdVentriculostomy ( ETV ), this method isa new method, needs special trainingand equipment and it is not suitable forall cases.
Management of Hydrocephalus (Cont.)Although shunt is the commonest method fortreatment it has some disadvantages: Shunt system is expensive. It is a foreign body, so during implantation if exposed tocontamination, this may lead to meningitis or encephalitiswhich may be lethal and in such cases shunt should beremoved. It is a narrow tube, so it is liable for obstruction (eitherproximal or distal end). It may over drain the CSF so devices must be selectedproperly according to the estimated intra-ventricular pressureof the patients.
Management of Hydrocephalus (Cont.)Medical treatment have no role in themanagement of hydrocephalus, sousing carbonic anhydrase inhibitor( Diamox ), will decrease the rate ofsecretion of CSF to some extent, butdoes not relief the obstruction somedical treatment may be used indoubtful cases or if there iscontraindication for surgery such asbronchopneumonia or infection at thesite of operation.
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