treatment of hydrocephalus at the wessex neurological centre mr ryan waters phd frcs (neuro surg)...
TRANSCRIPT
Treatment of hydrocephalus at the Wessex Neurological
Centre
Mr Ryan WatersPhD FRCS (Neuro Surg)
Consultant Neurosurgeon
Philosophy• To provide the highest quality service
– Outcomes– Patient experience
• Collaborative approach– Network partnerships with;
• Our referring Trusts• Oxford Children’s Hospital (Children’s Hospital Network)
– Third largest unit in the UK
Southampton Staff• Owen Sparrow• Nijaguna Mathad• Aabir Chakraborty• Ryan Waters• Christine Ward (Nurse practitioner)• 13 Paediatric Neurosciences nurses• Peter Gladwell (Surgical Practitioner)
Hydrocephalus• “An abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain”• but not the whole story?
Classification• Non-communicating/obstructive
– CSF flow obstruction
– Aqueduct stenosis– Tumour– Haemorrhage
• Communicating– Absorption problem
– Haemorrhage– Infection– Tumour– Inflammation
– ‘normal pressure hydrocephalus’– IIH
Common causes of hydrocephalus
Causes
Post head injury
Tumour
Patient Assessment-History & Examination
Is the child Unwell?
VomitingDrowsinessHeadachesSchool
performanceHead
circumferenceFontanelleBradycardia/
apnoeasSquintSunsetting
Treatment options• Treat the underlying cause• Temporary CSF drainage
– Lumbar puncture– Ventricular tap– EVD
• Endoscopic IIIrd ventriculostomy• Shunt
– VP– VA– VPleural
ETV
Shunt
Shunt hardware
Proximal and Distal Tubing Selection
Antibiotic impregnated catheters
Bactiseal
Silverline
More than 20 studies on Bactiseal
Some evidence that Bactiseal reduces shunt infections
Need for a multicentre randomised controlled study - BASICS
Shunt Blockage
Southampton Children's Hospital
Shunt Malfunction
Shunt Disconnection
Southampton Children's Hospital
Southampton Children's Hospital
Diagnostic Shunt Tap
• Aseptic Technique• Measure Opening
Pressure• If Possible Remove
Adequate Volume of CSF
• Send Specimens to Chem, Micro & Culture
NB Facilitated by System with
ReservoirSouthampton Children's Hospital
Normal Pressure Hydrocephalus• Generally seen in older adults• Communicating hydrocephalus
• Clinical triad– Cognitive decline– Gait disturbance– Urinary incontinence
• Ventriculomegaly on imaging
Investigation at WNC• MDT with neurology, neuropsychology, neurosurgery
• Assessment– Neuropsychology– Walking test– CSF infusion test– CSF drainage
Treatment at WNC• VP shunt
– Programmable valve– Risk of overdrainage and subdural formation
Idiopathic Intracranial Hypertension• Not ‘hydrocephalus’ but often treated with a shunt
– A venous disorder• Multidisciplinary approach; neurology, neurosurgery and neuroradiology
– Venography, manometry and stenting where possible
– but shunts still used to control ICP