Hydrocephalus disease and its relationship with cerebral shunt
Hydrocephalus is the accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain.... This fluid is responsible for nourishing and protecting the brain and spinal cord.... About 600cc of fluid is produced and reabsorbed daily, and despite this, the volume of this fluid is around 150cc. are hydrocephalus, which shows the importance of cerebral shunts in the field of neurosurgery.. ventricles and as a result improving the patient's symptoms.
### **What are the causes of hydrocephalus?**
Hydrocephalus can have various causes. Some of these causes are:
- Congenital causes: a child may be born with hydrocephalus.
- Cerebral tumor: These tumors can lead to hydrocephalus by causing obstruction in the drainage of cerebrospinal fluid.
- Head trauma: Head trauma can interfere with fluid reabsorption.
- Meningitis: Meningitis can also lead to hydrocephalus by disrupting fluid reabsorption.
### **What are the symptoms of hydrocephalus?**
Hydrocephaly can be acute or chronic....In acute hydrocephalus, the patient experiences headache, blurred vision, diplopia, and decreased level of consciousness and sleepiness...We said that hydrocephalus is associated with the accumulation of fluid inside the skull and leads to increased intracranial pressure (ICP)...Also, the eyes of these children deviate downwards, which is called sunset eyes.
In patients with hydrocephalus, there may be a series of hormonal disorders such as lack of menstruation (amenorrhea), milk secretion from the breasts (galactorrhea), excessive drinking (polydipsia) and excessive urination (polyuria).
### **How is hydrocephalus diagnosed?**
The best way to diagnose hydrocephalus is MRI of the brain... It may be possible to diagnose the cause of hydrocephalus (such as tumors) with the help of MRI.
Types of brain shunts
There are two general categories for brain shunts.
The first classification is based on the location of the liquid discharge.. According to this classification, the types of cerebral shunts are:
- ** Ventricular-peritoneal shunt:** This type of cerebral shunt transfers excess fluid from the cerebral ventricles to the peritoneal cavity.
- ** Ventricular-pulmonary shunt:** In this type of cerebral shunt, excess fluid is transferred from the cerebral ventricles to the pleural cavity, which is located around the lungs.
- ** Ventricular-atrial shunt:** This type of shunt transfers excess fluid from the ventricles of the brain to the atria of the heart.
-** Lumbar-peritoneal shunt:** This type of shunt removes fluid from the lumbar spinal cord and transfers it to the peritoneal cavity.
Another classification for cerebral shunt is based on the type of valve:
- Constant pressure valve: in this type of cerebral shunt, the pressure at which the valve opens is adjusted and used for the patient. Usually, after some time, surgery is needed again to adjust the valve pressure.
- Variable pressure valve: This type of valve was introduced in 1980, and with its help, one of the important challenges in installing a brain shunt, i.e., setting the appropriate pressure, was solved to some extent.... If the device is not set to the appropriate pressure (i.e., the patient's symptoms remain, such as leg headache), the pressure can be re-adjusted with the help of a magnet, and there is no need for another surgery.
The best type of brain shunt
Currently, the best type of cerebral shunts are ventriculo-peritoneal and lumbar-peritoneal shunts. The use of ventriculo-atrial and ventriculo-pulmonary shunts is limited because they can lead to pulmonary edema and heart failure in the long term.
Also, cerebral shunts with variable pressure valves are better than fixed pressure types.. because it is much easier to adjust the pressure in them and there is no need for re-surgery.
Is brain shunt permanent? Since 1950, when the first shunts were introduced, the technology used in them has not changed much....it is possible for the cerebral shunt to be blocked, broken, detached, etc....the valve may not work properly after some time and the person experiences too little or too much emptying...in a ten year period it reaches 98%...
Therefore, the normal lifespan they consider for a brain shunt is two years.
In cases where a person's hydrocephalus may be temporary and resolves after a while, in such cases there is no need to implant a new brain shunt.. But in most cases, a new brain shunt must be placed for the person, which also requires a new surgery.
Cerebral shunt care
Cerebral shunt requires a series of special cares.... These cares can not only increase the durability of the brain shunt and postpone the need to repeat the surgery, but also reduce the risk of a series of complications such as infection.
Some of these cares include:
- Avoid washing and shampooing your hair until the stitches are completely removed... The time to remove the stitches varies from 7 to 14 days.
- Parts of the shunt can be felt under the skin and may even be seen.... Do not manipulate or squeeze it in any way.
- After discharge from the hospital, you can continue to eat (unless the doctor advises for other reasons).
- Avoid doing activities that may injure your head and neck, such as martial arts.
- Doing sports activities is not prohibited and it can even to some extent remove the feeling of confusion after the operation.
- If there is pain, you can use a series of pain relievers.... For children under 4 years, acetaminophen is mainly prescribed.. But for adults, stronger pain relievers may be needed.
Symptoms of cerebral shunt failure
If you have the following symptoms, tell your doctor and let him know your condition.... These symptoms can indicate blockage or infection in the brain shunt path:
- Confusion, decreased level of alertness and sleepiness
- High fever
- neck stiffness
- Headache
- double vision or blurred vision
- Loss of appetite, nausea and vomiting
- convulsions
- swelling of veins located in the skull or swelling of the skin on the skull (for children)
- Swelling, redness, pain and discharge of purulent secretions from the brain shunt insertion site
Complications of cerebral shunt in adults
Some of these complications are:
- Infection: the brain shunt may become infected... - Obstruction: the brain shunt may be blocked, in such cases hydrocephalus symptoms such as headache will recur in the person.
- Cerebral hemorrhage: in cases where the surgery is not performed correctly, a person may experience cerebral hemorrhage and stroke, which is not very common.
- Abdominal fluid, lung and heart failure: due to the discharge of excess fluid into the three mentioned cavities, this fluid may collect inside these cavities and cause problems in the long run... Of course, this is not very common.
