Hydrocephalus 👉 VP Shunt, ETV, ETV/CPC, EVD and ICP bolt

Hydrocephalus derives from two Greek words ‘hydro’ meaning water and ‘cephalus’ meaning head. This condition occurs when excessive cerebrospinal fluid (CSF) accumulates in the brain.

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Hydrocephalus can be caused by the following conditions:

  1. A blockage of the CSF flow (within either the ventricles or subarachnoid space)
  2. A failure of absorbing CSF
  3. An increased CSF production – very rare

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The main symptoms of hydrocephalus are headaches, nausea and vomiting. In addition, there are other age-related symptoms, such as increased head size in babies.

 

Anatomy review:

Before exploring the different surgical procedures related to Hydrocephalus, it is important to understand the anatomy involved with the CSF production and its flow.

  • Choroid plexus: site where CSF is produced. It is formed by the vascularized invaginations of pia mater into ventricles;
  • Ventricles: there are 4 ventricles in total – right and left lateral ventricles, 3rd ventricle and 4th ventricle;
  • Interventricular foramen (also known as Foramen of Monro): structure that connects the lateral ventricles to the 3rd ventricle;
  • Cerebral Aqueduct (also known as Aqueduct of Sylvius):  narrow and curved channel that connects the 3rd ventricle to the 4th ventricle. It contains no choroid plexus.

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Fig.1 The ventricular system of the human brain (lateral view)

 

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 Fig.2 The ventricular system of the human brain (anterior view)

 

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Fig.3 The choroid plexus

 

 

Surgical Procedures:

Below some of the surgical procedures related to Hydrocephalus condition are briefly described.

Ventriculoperitoneal (VP) shunt: as the name suggests, the catheter that is inserted diverts the cerebrospinal fluid (CSF) from the lateral ventricles of the brain into the peritoneum.

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Endoscopic third ventriculostomy (ETV): treatment in which an endoscope is used to puncture a membrane in the floor of the third ventricle creating a pathway for CSF flow within the cavities in the brain.

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Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization (ETV/CPC):
this tretament is similar to the above, with an addition of a of choroid plexus cauterization; only performed in infants.

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External Ventricular Drainage (EVD):
a treatment that allows the temporary drainage of cerebrospinal fluid (CSF) from the ventricles of the brain, relieving raised intracranial pressure.

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Intracranial pressure (ICP) bolt: is a monitoring device that measures the intracranial pressure, by inserting a pressure monitor through the skull. It may be indicated after a head injury or post- surgery to the brain.

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References:

brainfoundation.org.au – Hydrocephalus

gosh.nhs.uk – evd

gosh.nhs.uk – icp bolt

uhs.nhs.uk – evd

emedicine.medscape.com

hydroassoc.org

neurology.mhmedical.com

kenhub.com

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Author: Sofia Gonçalves

...dreaming about creativity :)

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