Tuesday, May 23, 2017

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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