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Hydrocephalus

General

Hydrocephalus is a condition with an increased volume of cerebrospinal fluid (CSF) and distention of the brain's natural cavity, the ventricle system. Such an accumulation of CSF is normally due to an obstruction of the natural drainage system.

The consequence of hydrocephalus is an increased intracranial pressure (ICP).

Patients with a suspected elevated ICP and children with abnormal circumference of the head must be evaluated for treatment. Hydrocephalus is an important neurosurgical condition which, if left untreated, leads to considerable morbidity and mortality.

In many cases, the problem is not solved by treating the basic condition and the patient must have decompression of the CSF.

Treatment alternatives for hydrocephalus:

  • Surgical removal of tumor
  • Ventriculocisternostomy
  • Shunt

Ventriculocisternostomy

Non-communicative hydrocephalus with intact resorption apparatus can, for example, be due to:

  • Expansive processes in the cerebrofluid system, e.g. intraventricular tumors
  • Expansive processes outside the cerebrofluid system, e.g. paraventricular tumors around the 3rd. ventricle or in the posterior cranial fossa 

A ventriculocisternostomy should bypass the blockage (the tumor) and lead the CSF to the resorption areas on the surface of the brain.

Using the endoscopic technique, a hole or stoma can be made in the floor of the 3rd. brain ventricle (endoscopic third ventriculostomy). CSF will then flow to the basal cisterns and out to the surface of the brain and its resorption apparatus. In this way, blockages in the aqueduct can be circumvented and shunt treatment can be avoided.

About 70% of patients with non-communicative hydrocephalus will respond positvely to such a procedure.

Shunt

Communicative hydrocephalus with failing resorbtion apparatus can, among other things, be due to:

  • Increased venous pressure due to tumors that invade venous sinuses, e.g. meningiomas

With the aid of a shunt, the CSF is bypassed out of the cranium to an alternative resorption apparatus.

A shunt is a silicon tube system with a valve that leads CSF to the peritoneum (ventriculoperitoneal shunt) or to the blood stream (ventriculoatrial shunt).

Indications

  • Drainage obstruction by a tumor in the natural drainage system (non-communicating hydrocephalus)
  • Venous obstruction by a tumor (communicative hydrocephalus)

Goal

  • Achieve normalization of the intracranial pressure and the circulation of CSF

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