HYDROCEPHALUS

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Last Updated : 1/4/2011
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SANTOSH KARMARKAR
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There is no known way to prevent or cure hydrocephalus. If obstruction is found on CT scan due to a tumor or cyst, it can be excised by a neurosurgeon to re-establish the CSF pathway. In other situations the most effective treatment is insertion of a shunt (at a known pressure gradient). The shunt is a hollow silicone tube, placed into the ventricular system, diverting the CSF flow to the peritoneal cavity of the abdomen (

VP shunt

). If abdominal cavity is unable to absorb the fluid due to some disease viz. TB or cyst, the shunt can be placed via the jugular vein to reach the right atrium of heart (

VA shunt

). Shunts can also be placed in the pleural (chest) cavity.


V-P Shunt and V-A Shunt


In communicating hydrocephalus (malabsorption of CSF but no blockage) a Lumboperitoneal (LP) shunt can also be performed on order children where the tube goes from the spinal cavity to abdomen.

The operation to insert a shunt is performed with extremely strict sterile precautions by either a pediatric surgeon or neurosurgeon. This procedure takes about 1-2 hours.

After operation
The child will be observed for a short time, in the recovery area and then transferred to the bed. He/she will be allowed fluids after 12 hours and normal food after 24 hours.

Usually after 5-7 days the child can go home. Sometimes, a CT scan may be repeated to confirm the success of the treatment.

Endoscopic treatment
In selected cases as judged by the neurosurgeon, endoscopic procedures may be used to create alternative CSF pathway(s) within the brain (e.g. third ventriculostomy, aqueductal stenting) and shunt may not be necessary.

These techniques are developing and may find wider applications in the future.

How long is the

shunt tube

kept?
The shunt tube, unless blocked or infected by itself causes no problem and can be kept in place for years. Only if the surgeon is convinced that it is safe to remove the shunt, it may be removed. In many cases the tube is kept for a lifetime without causing any problems.



Contributor Information and Disclosures SANTOSH KARMARKAR
Consultant Pediatric Surgeon, Lilavati Hospital, Mumbai, India


First Created : 1/3/2001
References
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