Hydrocephalus in children. Eva Brichtova, M.D., Ph.D., Department of Pediatric Sugery, Orthopaedics and Traumatology, University Hospital Brno
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1 Hydrocephalus in children Eva Brichtova, M.D., Ph.D., Department of Pediatric Sugery, Orthopaedics and Traumatology, University Hospital Brno
2 Ventricle system
3 Ventricle system, cerebral cisterns
4 Hydrocephalus taxonomy hypersecretion hyporesorbtion internal external obstructive (non-communicating) communicating (non-obstructive) congenital acquired posthaemorrhagic postinfekctious posttraumatic active arrested
5 Signs and symptoms Makrocephaly, fontanelle bulging, setting sun sign, Parinaud sy Intracranial hypertension cephalea diffuse, valve headache, reverse Tinnel s sign vomitus explosive, no nausea vertigo seazures unconsciousness respiratory and cardiac arrhytmia
6 Hydrocephalus
7 Diagnosis of hydrocephalus Neurology examination Neuroimaging modalities ultrasound CT MRI Ocular fundus
8 Cerebral ultrasound examination
9 Cerebral CT
10 Cerebral MRI
11 Posthaemorrhagic hydrocephalus ultrasound imaging
12 Posthaemorrhagic hydrocephalus CT imaging
13 Hydrocephalus treatment Medical Surgery
14 Hydrocephalus treatment temporary Medicamentose (diuretics) Spinal tap Ventricular punction Ventricular drainage Lumbar drainage
15 Posthaemorrhagic hydrocephalus temporary treatment
16 Surgical treatment of hydrocephalus Drainage shunting VA, VP, (Nulsen, Spitz, Holter, Pudenz) Neuroendoskopy techniques
17 Surgical treatment of hydrocephalus A. Eliminating of obstruction cause (e.g. tumor exstirpation) B. Arteficial CSF communication (neuroendoskopy, Stoockey Scarff) C. CSF drainage
18 Drainage Most common surgery performed Communication between the ventricles and CSF resorbtion space
19 Drainage modifications Ventriculo peritoneal VP (pic. 1) Ventriculo atrial VA (pic. 2) Lumbo peritoneal (pic. 3) 1 2 3
20 Drainage modifications Ventriculo subgaleal Ventriculo pleural Torkildsen
21 V-P drainage Ventricular catheter Valve Peritoneal catheter
22 Insertion of ventricular catheter Dorso-frontal Parieto-occipital
23 Valves non programmable Valve opening pressure: low pressure 50 mm H 2 O middle pressure 100 mm H 2 O high pressure 150 mm H 2 O
24 Programmable valves system Codman
25 Programmable valves system Strata Medtronic
26 Surgery drainage VP shunt patient positioning
27 Surgery - drainage - VP shunt
28 Surgery - drainage - VP shunt
29 Surgery - drainage - VP shunt
30 Surgery - drainage - VP shunt
31 Surgery - drainage - VP shunt
32 Shunt malfunction Neurological examination Fundus oculi Percutanneous valve test Velve pressure resetting (programable valves only)
33 X-rays system Codman valve markers
34 Laboratory examinations FW, blood count, inflammation markers, serum osmolarity CSF examination valve punction (bakcteriology, biochemistry, cytology)
35 X-rays
36 X-rays
37 Ultrasound
38 CT
39 MRI Cave programmable valves
40 Central (ventricular) catheter malfunction blood clot obturation
41 Central (ventricular) catheter malfunction chorioideal plexus adhesions
42 Central (ventricular) catheter malfunction malposition
43 Central (ventricular) catheter malfunction Surgical treatment catheter repositioning or replacement
44 Valve malfunction Blood clot obturation Elevated CSF viscosity (inflammatory process) Slit ventricle syndrom
45 Distal catheter malfunction Unsufficient catheter lenght due to pts growth (X rays) Distal catheter malfunction causes: Continuity cut-off Peritoneal adhesion Peritoneal pseudocyst septic aseptic Peritonitis due APE Hyporesorbtion ascites Catheter intolerance, catheter expulsion Displacement to subcutaneous tissue Intestine perforation Hernia inguinalis, umbilicalis Atrial catheter malfunction causes Catheter thrombus (heart ultrasound)
46 Unsufficient catheter lenght due to pts growth
47 Continuity cut-off Diconnection Disruption
48 Treatment immediate surgery Re-connection if possible Catheter replacement (removing the displaced one)
49 Peritoneal catheter distal end - pseudocyst Ultrasound Septic: elevated CRP, FW, leukocytosis
50 Peritoneal adhesions Localized laparoskopy, catheter deliberation, replacement Difffuse temporary external drainage Intraluminal catheter replacement
51 Laparoskopy 3D, system Viking
52 Infectious complication Drainage extraction Temporary external drainage Antibiotics
53 Neuroendoscopy 1923 Mixter first 3rd ventriculostomy 80. neuroendoskopy techniques (flexible endoskopy, assisted endoskopy)
54 Neuroendoskopy
55 Neuroendoskopy Exstirpatio and biopsy of intra or periventricular expansions Cyst marsurpialisation Aqueductoplasty Third ventriculostomy
56 Indications for Neuroendoskopy Obstructive hydrocephalus Ventricular catheter implantation or replacement Ventricular (paraventricular) tumors Arachnoideal cyst Subdural space revision
57 Neuroendoskopy complications Haemorrhagy Hyperthermia (aseptic) Pneumocephalus Periventricular tissue damage CSF fistula Infection SD haematoma
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