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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