Introduction
A hydrocephalus/hydrocephalus refers to a dilatation of the ventricles of the brain, in which the cerebrospinal fluid is located. Depending on the cause, hydrocephalus is classified more closely; either the outflow, production or absorption of the cerebrospinal fluid may be abnormally altered. Indications of hydrocephalus can be complaints such as headaches, nausea, psychological changes, disturbance of consciousness or, in children, an increase in the circumference of the head.
Therapy for hydrocephalus
A hydrocephalus is usually treated surgically. However, in the case of an underlying disease, such as a tumor, it is important that this is treated superficially. The surgical treatment of hydrocephalus consists in the drainage of the liquor with the help of a shunt.
There are two different options for shunt placement, either with drainage into the atrium (ventriculo-atrial shunt) or into the abdominal cavity (ventriculoperitoneal shunt). The treatment of hydrocephalus is somewhat different if an acute hydrocephalus occurs as an emergency situation. In such a case, a ventricular drainage is first applied by means of a so-called ventriculocisternostomy and only later a shunt is applied to treat the hydrocephalus.
In a ventriculocisternostomy, the liquor is drained into a cistern of the subarachnoid space (cisterna magna). Postoperatively, regular checks of the applied system follow and, if necessary, medication against nausea (anticonvulsants) is administered. A number of complications can occur with these draining systems for the therapy of hydrocephalus. These include a valve insufficiency with insufficient or excessive drainage, displacement of the shunt volume, infection of the cerebrospinal fluid space with subsequent meningitis or encephalitis. Epileptic seizures (epilepsy), cerebral infarction or bleeding can also occur.
What is a shunt?
In medicine, a shunt is a natural or artificial connection between two normally separated body cavities. The connection allows the body fluids to pass between the compartments involved. In the context of a hydrocephalus, too much brain fluid is produced in the ventricle system of the brain.
Since this cannot drain off sufficiently, the cerebral pressure increases and can lead to serious symptoms such as deformation of the head, nausea, headaches, visual disturbances and seizures. In order to keep the cerebral pressure at a normal level, the excess cerebral fluid is drained via a shunt into another body cavity, such as the abdominal cavity. Such a shunt is a particularly thin plastic tube.
With a valve in between, the tube runs under the skin, starting from the head, behind the ears and along the neck to the abdomen or in some cases to the atrium of the heart. This is where the cerebral fluid can then be absorbed. The valve, which is inserted in the course of the shunt, can be used to subsequently regulate the flow of cerebral fluid.
In most cases, a so-called VP shunt (ventriculo-peritoneal shunt) is created to treat hydrocephalus. This is a flexible plastic tube that is led from a posterior chamber in the ventricle system of the brain, under the skin and into the abdominal cavity. Prior to the operation, the course of the shunt is precisely planned and the length of the catheter and the size of the valve are individually adapted to the patient.
The operation is performed by an experienced neurosurgeon under general anesthesia. Three precise skin incisions are made. One above the forehead in the right hairline, one behind the ear and a third approximately two to three centimeters next to the navel.
The tube is then advanced from a posterior chamber in the ventricle system into the abdomen and connected to the ventricle system. Afterwards, the correct position of the catheter and the drainage of the cerebral water is checked in the operating room before the skin incisions are closed again. The operation lasts about 45 minutes, in some cases a little longer.
Is your family planning a shunt operation? Prepare for it with our next articles:
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The creation of a shunt for the therapy of hydrocephalus is considered a routine procedure in neurosurgery, but there are postoperative complications that should be considered. Acute complications, such as a cerebral hemorrhage or injury to vessels, occur very rarely.
If the valve is not correctly adjusted, a so-called excess drainage may occur in the course of the operation. In this case, too much cerebral water runs off via the shunt, resulting in a negative pressure. This condition can be accompanied by symptoms such as nausea, vomiting, dizziness or visual disturbances.
Since a shunt is a foreign body, there is always a risk of infection. If the infection is severe, it can lead to fever, redness or swelling of the wound, increased inflammation values, clouding of consciousness or even seizures in the baby. If an infection of the shunt system is suspected and no other cause for the symptoms can be proven, surgical removal is necessary in most cases.
Our next article may also be of interest to you: What are the consequences of a cerebral hemorrhage? After shunt surgery a complex and regular follow-up treatment of the patient is necessary. After the operation, the patient must first be observed as an inpatient.
The outflow of cerebral fluid is checked and, if necessary, the valve and the strength of the outflow are corrected. After the operation, an X-ray is taken to check the course of the shunt. In babies, in addition to the x-ray, an ultrasound examination of the skull can be performed to examine the course of the shunt.
In addition, regular wound checks should be carried out in the clinic in the first few days and then by the family doctor. The controls after a shunt operation should be carried out every 3 – 6 months in the neurosurgical outpatient clinic of the surgeon, so that a comprehensive physical examination as well as further shunt and wound controls can be carried out. If there are any abnormalities in the course of the shunt or the wound, further examinations such as a laboratory sample or an X-ray may be necessary.
An unscheduled presentation of the patient should be made if fever, nausea, vomiting, abdominal pain, vision problems or seizures occur. These symptoms may indicate increased pressure in the brain or the presence of a serious infection. In addition, each patient should be given a card on which all information regarding the shunt is written and on which the checks made and any changes made can be entered. The following topics could also be of interest to you:
- Inflammation of a wound
- Brain pressure sign
