Hydrocephalus is a life-threatening disease characterized by the presence of an excessive amount of fluid (cerebrospinal fluid) in the ventricles of the brain. If untreated, it leads to serious complications. Brain bypass surgery for hydrocephalus is the only way to get rid of the problem.
Description and danger of pathology
Cerebrospinal fluid normally circulates continuously in the brain. It not only protects it from infectious agents, but also provides nutrients. Under the influence of negative factors, CSF production may increase or its outflow may be difficult.
If the ventricles become full of fluid, their walls become thin, intracranial pressure increases, and tissue rupture can occur. Such a pathology is characterized by neurological disorders.
Hydrocephalus can cause complications. These include:
- Delayed mental and physical development in infants.
- Psychical deviations.
- Changes in the emotional sphere in children and adults.
- Violation of cognitive processes (memory, attention), which leads to low school performance, difficult learning.
- The development of epilepsy.
- The appearance of hallucinations.
- Problems with motor functions, which leads to disability.
In the absence of timely treatment, irreversible changes occur in the brain, which cannot be compensated. A malignant form of the disease often leads to death.
Description of procedure
Brain bypass surgery for hydrocephalus is carried out in order to restore the circulation of cerebrospinal fluid and to protect the organ from negative consequences. For this, special systems are used, including shunts and thin silicone tubes. With their help, the fluid is diverted into the abdominal or other natural cavities of the body.
The procedure makes it possible:
- Stabilize the outflow of cerebrospinal fluid (it will not accumulate in the ventricles and increase intracranial pressure).
- Restore normal blood flow.
- Restore brain functionality.
After a brain bypass procedure with hydrocephalus, the patient is no different from healthy people. He quickly recovers and returns to normal life. But in some cases, such systems have to be used for life. Periodically they require replacement.
Shunt System Components
The system contains 2 catheters and a single-acting valve. A ventricular catheter is inserted into the ventricle of the brain, and a peripheral catheter into the abdominal cavity or right atrium. They are interconnected by a valve, which regulates the flow of cerebrospinal fluid unilaterally.
The valve is designed for a specific pressure range. Moreover, it is equipped with a special tank, which allows the specialist to "pump" the system. It is also used to collect cerebrospinal fluid for analysis with a thin needle or the administration of medications.
Indications for surgery
Before conducting brain bypass surgery with hydrocephalus, it is necessary to stabilize the patient's medication. So, the indications for intervention are as follows:
- Post-traumatic hydrocephalus with damage to the cranial bones.
- The penetration of cerebrospinal fluid 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
Ventricular bypass grafting with hydrocephalus is not always permitted. Contraindications are:
- Inflammatory processes in the area where the intervention will be performed.
- Severe respiratory disease.
- Heart disease.
- Oncological disease of the brain.
Replacement brain hydrocephalus in an adult is an acquired condition and also requires the supervision of doctors, therapy.
Types of surgical intervention
Brain bypass surgery for hydrocephalus in children is carried out immediately. However, a thorough examination is preliminarily carried out, as well as a choice of the type of surgical intervention. There are such types of it:
- Ventriculo-peritoneal. This is the most common type of operation. It provides for the installation of a shunt system so that the excess volume of cerebrospinal fluid is discharged into the abdominal cavity. Since catheters are placed under the skin, they remain invisible to others. The valve helps regulate the amount of fluid removed. There is no harm to the patient, since the extra 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 removed into the peritoneal cavity.
- The formation of porencephaly. With this type of operation, the ventricle of the brain and the subarachnoid space join. Such a procedure is unable to completely eliminate the problem and is temporary.
In adults, brain bypass surgery for hydrocephalus is the same as in children. However, the intervention carries certain risks, therefore, only an experienced surgeon can trust it to be performed.
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 has an acquired character, then he must prepare before the planned operation.
A week before the intervention, a person is forbidden to drink alcohol, smoke. You should also completely abandon the use of certain medications (steroids). They may increase the risk of bleeding.
Do not eat food the night before. In the morning it is forbidden to drink water. 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 before surgery.
Surgery
Mixed cerebral hydrocephalus is a difficult diagnosis, but it can and should be treated. Otherwise, a person will experience serious complications.
Surgery is performed under strictly sterile conditions. A hole is made in the skull box through which the shunt system is installed. It is also necessary to create a special tunnel under the skin in which catheters will be placed.
An intervention requires general anesthesia. The patient is completely covered with sheets. The surgical field is carefully treated with an antiseptic. Interventions 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
Adult brain replacement hydrocephalus can occur due to trauma and requires careful diagnosis. After the surgical intervention is done, a person may feel general weakness and malaise. This condition is quite normal. Nausea, dizziness also appears.
You can evaluate the success of the intervention only the next day after the installation of the shunt system. MRI is used to monitor the patient's condition. Re-examination is carried out after 7 days.
After the patient is discharged home, he will have to follow some recommendations of doctors:
- Refuse alcohol for the entire rehabilitation period. Moreover, it is better not to drink alcohol even after the completion of the recovery period.
- Since the patient will have to take medications, and also considering 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.
- You should often walk in the fresh air, but do not overwork.
The recommendations of specialists 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 reservoirs, as there is a risk of infection. The hole that remains in the skull must not be touched. Home mode is observed for a month.
Possible complications
The consequences of brain bypass surgery with 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 a patient is the entry of an infection or bacteria into the brain. The patient may also develop other complications:
- Damage to blood vessels and an increased risk of stroke.
- Infection of the abdominal cavity or gray matter of the brain, followed by the development of sepsis. The cause of the pathological process becomes staphylococcus. To prevent infection, antibiotics must be used.
- Organ damage causing epilepsy.
- Hydrodynamic dysfunction. Sometimes the system does not allow for 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 pressure change with the valve is required.
- Blood clots and blockage of blood vessels.
- Insufficient efficiency of the shunt system, its 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 extended.
Most of these complications can be avoided if you follow the advice of doctors.
Reason to see a doctor
There are different reviews about brain bypass surgery for hydrocephalus: some people are afraid of surgery because they do not have complete information about it. Most of the patients establish a normal full life, only occasionally visiting a doctor to monitor the system. However, sometimes you need to immediately consult a doctor. 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 a deterioration in the functionality of the brain;
- the appearance of skin allergies - most likely, it is provoked by drugs, so the list of prescribed drugs needs to be reviewed;
- gait change;
- confusion of consciousness;
- weakness in the arms and legs;
- nausea, vomiting, headache (is a sign of increased intracranial pressure, that is, the shunt has ceased to function).
Hydrocephalus is a difficult 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.