Hydrocephalus is a life-threatening disease characterized by the presence of an excessive amount of fluid (liquor) in the ventricles of the brain. If left untreated, it leads to serious complications. Brain bypass for hydrocephalus is the only way to get rid of the problem.
Description and danger of pathology
Cerebrospinal fluid normally constantly circulates in the brain. It not only protects it from infectious agents, but also provides nutrients. Under the influence of negative factors, the production of cerebrospinal fluid may increase or its outflow may be difficult.
If the ventricles overflow with fluid, their walls become thin, intracranial pressure increases, and tissue rupture may occur. This pathology is characterized by neurological disorders.
Hydrocephalus can causecomplications. These include:
- Mental and physical retardation in infants.
- Mental deviations.
- Changes in the emotional sphere in children and adults.
- Violation of cognitive processes (memory, attention), which leads to poor school performance, learning difficulties.
- Development of epilepsy.
- Appearance of hallucinations.
- Problems with motor functions, which leads to a person's disability.
In the absence of timely treatment, irreversible changes occur in the brain, which cannot be compensated. The malignant form of the disease is often fatal.
Procedure description
Brain shunting for hydrocephalus is performed in order to restore the circulation of CSF and protect the organ from negative consequences. For this, special systems are used, including shunts and thin silicone tubes. With their help, fluid is discharged into the abdominal or other natural cavities of the body.
The procedure enables:
- Stabilize the outflow of cerebrospinal fluid (it will not accumulate in the ventricles and increase intracranial pressure).
- Restore normal blood flow.
- Restore the functionality of the brain.
After a brain bypass procedure for hydrocephalus, the patient is no different from he althy people. He quickly recovers and returns to normal life. But inin some cases, such systems have to be used for life. They need to be replaced periodically.
Shunt System Components
The system includes 2 catheters and a one-way valve. The ventricular catheter is inserted into the ventricle of the brain, and the peripheral catheter is inserted into the abdominal cavity or right atrium. Between themselves, they are connected by a valve that regulates the flow of cerebrospinal fluid unilaterally.
The valve is designed for a certain pressure range. Moreover, it is equipped with a special reservoir, which allows the specialist to "pump" the system. It is also used to withdraw cerebrospinal fluid for analysis with a fine needle or to administer medications.
Indications for surgery
Before performing brain bypass surgery for hydrocephalus, it is necessary to stabilize the patient's condition with medication. So, the indications for intervention are as follows:
- Post-traumatic hydrocephalus with damage to the cranial bones.
- CSF penetration into the inner or outer layers of the brain as a result of mixed hydrocephalus.
- Rapidly progressive dropsy in children.
If the disease does not pose a threat to life, is regressive or there are serious contraindications, then the procedure is not performed.
Possible contraindications
Cerebral ventricular bypassbrain with hydrocephalus is not always allowed. Contraindications are:
- Inflammatory processes in the area where the intervention will be performed.
- Severe respiratory illness.
- Defect of the heart.
- Cancerous brain disease.
Replacement hydrocephalus of the brain in an adult is an acquired condition and also requires medical supervision, therapy.
Types of surgery
Brain bypass for hydrocephalus in children is carried out immediately. However, a thorough examination is carried out beforehand, as well as the choice of the type of surgical intervention. There are such types of it:
- Ventriculo-peritoneal. This is the most common type of operation. It involves the installation of a shunt system so that the excess volume of cerebrospinal fluid is discharged into the abdominal cavity. Since catheters are laid under the skin, they remain invisible to others. The valve helps to regulate the amount of liquid removed. There is no harm to the patient, since excess cerebrospinal fluid is absorbed by the intestines and excreted from the body naturally.
- Ventriculo-atrial. In this case, the fluid through the catheters enters the right atrium.
- Lumbo-peritoneal. Here the shunt system is installed not in the brain, but in the spinal cord. It is from here that the fluid is discharged into the peritoneal cavity.
- Formation of porencephaly. With this type of operation,connection of the ventricle of the brain and the subarachnoid space. This procedure is not able to completely eliminate the problem and is temporary.
In adults, brain bypass for hydrocephalus is performed in the same way as in children. However, the intervention carries certain risks, so only an experienced surgeon can be trusted to perform it.
Preparation for surgery
In the presence of cerebral hydrocephalus in newborns, shunting, as already mentioned, is carried out immediately. If the procedure is prescribed for an adult patient, and the disease itself is of an acquired nature, then he must prepare before a planned operation.
A week before the intervention, a person is forbidden to drink alcoholic beverages, smoke. You should also completely abandon the use of certain drugs (steroids). They may increase the risk of bleeding.
Don't eat food the night before. It is forbidden to drink water in the morning. And before the operation, you need to take a shower, wash well and shave your head in the place where the incisions will be made. All jewelry must be removed prior to surgery.
Progress of surgery
Mixed cerebral hydrocephalus is a difficult diagnosis, but it can and should be treated. Otherwise, serious complications await the person.
Surgery is carried out under strictly sterile conditions. A hole is made in the cranium throughwhich is the installation of the shunt system. It is also necessary to create a special tunnel under the skin in which catheters will be laid.
General anesthesia is required for the intervention. The patient is completely covered with sheets. The operating field is carefully treated with an antiseptic. Intervention on the brain should be carried out as accurately as possible, since even a millimeter deviation can lead to severe damage to the organ.
Rehabilitation after surgery
Replacement hydrocephalus of the brain in adults may occur due to trauma and requires careful diagnosis. After surgery is done, a person may feel general weakness and malaise. This condition is quite normal. Nausea and dizziness also appear.
Evaluate the success of the intervention is possible only on the next day after the installation of the shunt system. MRI is used to monitor the patient's condition. A re-examination is carried out after 7 days.
After the patient is discharged home, he will have to follow some recommendations from doctors:
- Refuse alcohol for the entire period of rehabilitation. Moreover, it is better not to drink alcohol even after the completion of the recovery period.
- Because the patient will have to take medication, and given that the operation was done on the brain, he should not drive.
- Physical activity should not be. It is forbidden to lift objects heavier than 1 kg.
- Stay outdoors more oftenbut don't overwork.
Recommendations of experts must be fully observed. Drugs should be taken in a strictly defined dosage. Within 2 weeks after the operation, it is forbidden to swim in any open or closed water bodies, as there is a risk of infection. The hole that remains in the skull must not be touched by hands. Home regime is observed for a month.
Possible Complications
The consequences of brain bypass surgery for hydrocephalus can be different. It all depends on the severity of the disease, the quality of the operation and the materials used. The most dangerous thing for the patient is the introduction of infection or bacteria into the brain. The patient may also develop other complications:
- Damage to blood vessels and increased risk of stroke.
- Infection of the abdominal cavity or gray matter of the brain, with subsequent development of sepsis. The cause of the pathological process is staphylococcus aureus. Antibiotics must be used to prevent infection.
- Injury to an organ causing epilepsy.
- Dysfunction of hydrodynamics. Sometimes the system does not allow to achieve normal pressure in the ventricles of the brain. Sometimes they change size, become like cracks. In this case, the therapy will be ineffective.
- Subdural hematoma. In most cases, it resolves on its own. If the outcome is unfavorable, drainage of the indicated area or a change in pressure with a valve is required.
- Clot formation and blockage of blood vessels.
- Insufficient efficiency of the shunt system, blockage or damage. Natural changes in the body can also lead to this, for example: the growth of the child, as a result of which the tubes need to be lengthened.
Most of these complications can be avoided by following the advice of doctors.
A reason to see a doctor
Reviews are different about brain bypass for hydrocephalus: some people are afraid of the operation, because they do not have complete information about it. The majority of patients establish a normal full life, only occasionally visiting a doctor to monitor the operation of the system. However, sometimes you need to see a doctor right away. So, you need to go to the hospital with the following symptoms:
- an increase in body temperature - this indicates the development of an inflammatory process that contributes to the deterioration of the functionality of the brain;
- appearance of skin allergy - most likely, it is provoked by drugs, so the list of prescribed drugs needs to be reviewed;
- changing gait;
- confusion;
- weakness in arms and legs;
- nausea, vomiting, headache (which is a sign of increased intracranial pressure, that is, the shunt has ceased to function).
Hydrocephalus is a complex and dangerous disease that can turn a person into a disabled person or lead to death. Installing a shunt allows you to solve the problem and provide the patient with a full life. But you need to install it in a good clinic and with an experienced doctor.
