Hydrocephalus (Ventriculoperitoneal Shunt System, Endoscopic Third Ventriculostomy)
It is one of the main problems that the field of pediatric neurosurgery deals with. “hydro=water” means “cephalos=head”. Hydrocephalus is an increase in water and pressure in the spaces in the brain. The human brain has small chambers called ventricles. These chambers are connected to each other by some kind of water channels. Cerebrospinal fluid is present in these channels. Cerebrospinal fluid is produced and absorbed continuously throughout the day. However, from time to time, excessive fluid accumulates in these small chambers due to congenital or causal reasons. Eventually, intracranial pressure increases. This condition is called hydrocephalus. Hydrocephalus is one of the most common diseases when it comes to pediatric neurosurgery. It is seen in approximately 2 out of every 1000 children born.
Symptoms
The most noticeable symptom of hydrocephalus is that the head is larger than normal. Other symptoms are as follows:
Newborn (First 1 month): Fontanelle tension, prominent veins in the head, vomiting, eyes looking down, seizure picture.
Baby (after 1 month): Headache, vomiting, delay in walking and speaking, double vision, seizure.
Diagnosis
The gold standard in the diagnosis of hydrocephalus is MRI. From time to time, the neurosurgeon may also resort to Cranial USG and/or CT imaging.
Why Does It Occur?
– Intraventricular hemorrhage in prematurely born babies
– Head injuries, brain tumors and infections
– Caused by spina bifida
– Genetic inheritance
Treatment
The treatment of hydrocephalus is surgery. There are two types of techniques: shunt surgery (ventriculoperitoneal shunt system) and endoscopic surgery (endoscopic third ventriculostomy).
1. Ventriculoperitoneal Shunt System
The aim is to transfer the fluid in the brain to a different part of the body and from there to remove it from the body. A shunt is a long, thin, elastic tube. Surgery allows this fluid in the brain to be transferred to the patient’s abdominal area. After infancy, it is not noticeable from the outside. It must be used until the end of life. Over time, the shunt can become blocked, broken, or infected. In this case, the shunt must be replaced. It is generally preferred in cases where endoscopic surgery is not possible.
2. Endoscopic Third Ventriculostomy
It is our first priority in the treatment of hydrocephalus. From where? Because, thanks to this method, children do not have to live with a foreign object in their bodies throughout their lives. In endoscopic surgery, the neurosurgeon enters the brain with a lighted camera whose tip is as thin as 2-4 mm. It reaches the third ventricle, one of the four chambers in the brain. With the help of the endoscope, it either opens the blocked channel that prevents the cerebrospinal fluid from flowing or creates a new path for the fluid to flow. In this way, the aim is for the excess cerebrospinal fluid to leave the body normally.
