Shunting of cerebral vessels with hydrocephalus

1 The essence and goals of the operation

Hydrocephalus( hydrocephalus) occurs as a result of a disturbance in the circulation of cerebrospinal fluid( cerebrospinal fluid, cerebrospinal fluid, CSF) from the ventricles of the brain where it is produced to the subarachnoid space where it is absorbed( absorbed).Then in the ventricles accumulate excess fluid, they increase in size and squeeze the brain structures. Absorption of the cerebrospinal fluid can also be impaired due to the atrophy of the arachnoid shell.

Because of the squeezing, brain functions are violated, which can lead to life-threatening conditions. In this case, intracranial pressure can be either increased, or decreased or normal.

With hydrocephalus, there is not a shunting of cerebral vessels, but a so-called cerebral bypass.

In this case, the task is to remove excess cerebrospinal fluid from the ventricles of the brain. The cerebrospinal fluid is withdrawn from the head to another body cavity where it can easily be excreted or digested:

• into the abdominal - then the operation is called "ventriculoperitoneal bypass",
• to the atrium - ventriculoatral bypass,
• into the bladder,
• into the pleural cavity.

The first two methods are most effective and are most often used. The shunt is carried out under the skin, which makes it completely invisible.

2 Expected results

After the cerebral bypass, the following occurs. Excess cerebrospinal fluid flows from the head and ceases to exert pressure on the structure of the brain. As a result:

• decreases the ventricles of the brain,
• normalizes cerebral circulation,
• is restored in whole or in part by brain work.

Immediately after surgery, the patient usually feels unwell, which may include the following symptoms:

• nausea,
• dizziness,
• numbness of the limbs,
• headache.

Such phenomena are normal for the postoperative period.

During rehabilitation, the patient should monitor his state of health. Some of its changes may indicate a developing complication. The doctor should be consulted in the following cases:

• if the gait changes,
• is confused,
• is constantly drowsy,
• has weakness in the hands or feet,
• a few weeks after the operation is still troubled by headache and nausea,
• allergic reactions to appointedmedicine,
• the temperature rises above 38 degrees( this symptom indicates an infection).

Also during the rehabilitation period, there may be side effects of the prescribed drugs, in particular, anticonvulsant, especially in people who have not previously taken it. In any case, the patient should consult with the doctor if anxiety symptoms appear.

3 Question of the effectiveness of

The results of the operation depend on what type of dropsy the patient had. The best results are obtained by shunting the brain with hydrocephalus associated with a violation of fluid absorption, for example, atrophy of the arachnoid shell.

With hydrocephalus associated with ischemia, the brain functions are not completely restored, but the patient's condition improves. With ischemia of the brain stem, shunting is ineffective, but it is associated with a risk of infection and worsening of the patient's condition, so this method of treatment in these cases does not apply.

Brain bypass is effective in children with congenital hydrocephalus.

It prevents brain development disorders. As the child grows, the shunt is changed. Although dependence on the shunt can be lifelong, the operation gives the child the opportunity to live and develop, keeping pace with peers. The prognosis in children with acquired edema is worse.

4 Risk of Complications

Any surgical intervention involves certain risks. With cerebrovascular cerebral bypass surgery, an opening is made in the skull, so the main danger is the possibility of infection, as well as damage to blood vessels. If the brain vessels have been damaged, hemorrhage, stroke, epilepsy or convulsive cider can develop, it is also possible for blood clots in the vessels of the head or abdominal cavity. The abdominal cavity or other, where the liquid is discharged, can be infected. Also sometimes, because of the hose, there are bedsores in the abdominal cavity.

It should be noted that complications often occur not because of an incorrect operation, but because the patient does not follow the doctor's recommendations in the postoperative period.

For example, after surgery, you can not touch the hole in your head with your hands, bathe in open water, lift weights. Also among the negative consequences - the patient's constant dependence on the shunt.

As a result of surgery, the following complications can also occur:

• Hyperdraination - due to too much fluid outflow, hematomas, "sticky ventricles" syndrome, may occur. More often, hyperdrilling syndromes develop in patients with shunts with low opening pressure, responding to a slight excess of fluid. Such conditions are treated conservatively or by changing the shunt to another, with a higher pressure.
• Gipodrenirovanie - too weak outflow of fluid, this means that the shunt can not cope with its task. The problems of hyperdrilling and hypodrenation are solved with the help of modern shunts with controlled pressure. There are, for example, shunts with a change in opening pressure for vertical and horizontal position. Also there are devices with a spring mechanism that smoothly regulates the pressure at different positions of the person( sitting, lying, standing, with a head thrown back, etc.).
• Disconnection of the shunt system with possible displacement of its ends.
• Clogging on any part of the system.
• Purulent-septic complications - meningitis, meningoencephalitis, ventriculitis, sepsis, abscess - are caused by infection. In this case, removal of the shunting system, antibiotics is shown, then a new shunt is implanted no earlier than 16 days later.
• Complications associated with improper operation of the end of the shunt, located in the abdominal cavity, atrial, etc. It can be pseudocysts in the abdominal cavity, with the removal of the shunt into the atrium - endocarditis.

Shunting in hydrocephalus allows to reduce intracranial pressure, to prevent squeezing of the brain and disruption of its work, to avoid the development of conditions that threaten life. As with any surgery, especially associated with the introduction of foreign bodies into the body, with shunting there is a risk of complications. Also shunting is not effective for all types of hydrocephalus. At present, the promising direction is endoscopic operations, with the help of which it is possible to create bypass ways of outflow of the CSF and not to install a shunt.