Pediatric Surgery Hydrcaphelos

Surgery for Hydrocephalus

Definition

In cases of big head with ventricular dilatations due to excessive accumulation of cerebrospinal fluid in the brain resulting in rise in intracranial pressure in conditions of:

•   Congenital acqueductal stenosis

•   Associated meningomyelocele

•   Complications of pyogenic and tubercular meningitis.

Objectives

•   To drain the exess of CSF from ventricles to the peritoneal cavity

•   To reduce the intracranial tension

•   To insert a ventriculoperitoneal silastic shunt.

Position

•   Supine with neck extended and rotated to the left side

•   Pinna stapped in front of tragus.

Anesthesia

General.

Procedure

   1.  A curved scalp incision, 5 cm long, above and behind the pinna over the parietal eminence.

   2.  Incise and reflect the periosteum.

   3.  Make one cm sized burr hole with a trephine.

   4.  Cauterize the dura to make a tiny hole.

   5.  Insert the ventricular catheter to ensure CSF flow.

   6.  Prevent excessive CSF drainage.

   7.  Open the peritoneal cavity in the right subcostal region.

   8.  Make a subcutaneous tunnel from the head to the abdominal wound.

   9.  Place the lower end of the shunt in the pelvis or the suprahepatic space.

10.  Close all wounds in 2 layers.

Options

1.  Ventriculoatrial shunt instead of ventriculoperitoneal.

2.  Choice of an indigenous or an imported shunt.

Special Instruments

•   General pediatric surgical set

•   Special instruments include:

     a.  Trephine (1 cm)                           1 (Fig. 17.26)

     b.  Brain needle and cannula           1 (Fig. 13.47)

     c.  Periosteal elevators                      2

     d.  Guarded clamps                           2

     e.  Mastoid retractors                        2 (Fig. 21.3)

     f.   Ventriculoperitoneal shunt        1

     g.  CSF sample bottles                     3

     h.  Red rubber catheter # 10            1

Sutures

•   4/0 Catgut                                          2

•   5/0 Nylon                                           1

•   4/0 Silk                                               2

•   1/0 Silk                                               1

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