Internal Medicine

Therapy of the water head

introduction

A Hydrocephalus/ Water head refers to an enlargement of the ventricles of the brain, in which the nerve water, the Cerebrospinal fluid, is located.

Depending on the cause, a hydrocephalus is classified more closely; either the discharge, the production or the absorption of the CSF may be abnormally changed. Symptoms of hydrocephalus can be symptoms such as headache, nausea, psychological changes, impaired consciousness or, in children, an increase in the size of the head.

Therapy for a water head

A head of water is usually treated surgically. However, in the case of an underlying disease, such as a tumor, it is important that this is primarily treated. The operative supply of the water head consists of the liquor drainage with the help of a shunt. There are two different shunt placement options, either with a lead into the atrium (ventriculo-atrial shunt) or in the abdominal cavity (ventriculoperitoneal shunt).

The water head therapy looks a little different when an acute water head occurs as an emergency situation. In such a case, a ventricular drainage is first applied using a so-called ventriculocisternostomy and only later a shunt is applied to treat the hydrous head. In a ventriculocisternostomy, the CSF is drained into a cistern in the subarachnoid space (Cisterna magna).

Postoperatively, regular checks of the applied system follow and medication against nausea (Anticonvulsants) administered.

A number of complications can arise with these drainage systems for treating water head. These include valve insufficiency with insufficient or excessive drainage, relocation of the shunt volume, infection of the CSF space with subsequent meningitis (meningitis) or encephalitis (Encephalitis). In addition, epileptic seizures (epilepsy), cerebral infarction or bleeding can occur.

Read more on the topic: Postoperative Complications

What is a shunt?

In medicine, a shunt is a natural or artificial connection between two normally separate body cavities. The connection enables the body fluids to pass between the compartments involved.

Too much cerebrospinal fluid is formed in the ventricular system of the brain as part of a water head. As this cannot drain off sufficiently, the intracranial pressure increases and can lead to serious symptoms such as deformation of the head, nausea, headache, visual disturbances and seizures.

In order to keep the intracranial pressure at a normal value, the excess cerebrospinal fluid is diverted via a shunt into another body cavity, such as the abdomen.

Such a shunt is a particularly thin plastic tube. With the interposition of a valve, the tube runs under the skin, starting from the head, behind the ears and along the neck to the abdomen or in some cases into the atrium of the heart. The brain water can then be absorbed here. The valve, which is interposed during the course of the shunt, can be used to subsequently regulate the drainage of the brain water.

How does a shunt operation work?

In most cases, a so-called VP shunt (ventriculo-peritoneal shunt) created. This is a flexible plastic tube that is drained from a posterior chamber in the ventricular system of the brain, under the skin, into the abdominal cavity.

Before the operation, the course of the shunt is planned precisely and the length of the catheter and the size of the valve are individually tailored to the patient. The procedure is performed by an experienced neurosurgeon under general anesthesia.

Three precise skin incisions are made. One above the forehead in the right hairline, one behind the ear and a third about two to three centimeters next to the navel. The tube is then pushed from a posterior chamber in the ventricular system into the abdomen and connected to the ventricular system. The correct position of the catheter and the drainage of the cerebral fluid are then checked in the operating room before the skin incisions are closed again. The operation takes about 45 minutes, in some cases a little longer.

Is your family going to have a shunt operation? Prepare for this with our next articles:

General anesthesia - procedure, risks and side effects
General anesthesia in children - what should be considered?

What are the risks of shunt surgery?

The creation of a shunt for the therapy of a water head is to be regarded as a routine procedure in neurosurgery, but there are postoperative complications that should be considered.

Acute complications, such as cerebral haemorrhage or an injury to blood vessels, occur very rarely.

If the valve is not set correctly, overflow drainage can occur. Too much cerebral fluid drains through the shunt, creating a negative pressure. This condition can be accompanied by symptoms such as nausea, vomiting, dizziness, or visual disturbances.

Since a shunt is a foreign body, there is always a risk of infection. Severe infections can lead to fever, redness or swelling in the course of the wound, increased inflammation values, clouding of consciousness or even seizures in the baby. If an infection of the shunt system is suspected and no other cause for the symptoms can be proven, surgical removal is necessary in most cases.

Our next article could also be of interest to you: What are the consequences of a cerebral hemorrhage?

What is the follow-up treatment like?

Complex and regular follow-up treatment of the patient is necessary after a shunt operation. After the operation, the patient must first be observed in the hospital.

The drainage of the brain water is checked and, if necessary, the valve and the flow rate are corrected. After the operation, an X-ray is taken to check the course of the shunt. In babies, in addition to the X-ray, you can also do an ultrasound scan of the skull to examine the course of the shunt. In addition, regular wound checks should be carried out in the clinic in the first few days and then by the family doctor.

Read more on the topic: Wound healing disorder

What checks do you have to do afterwards?

Checks after a shunt operation should be carried out every 3 to 6 months in the surgeon's neurosurgical outpatient department so that a comprehensive physical examination as well as further shunt and wound checks can be carried out.

If there are abnormalities in the course of the shunt or the wound, further examinations, such as a laboratory sample or an X-ray, may be necessary. An unscheduled presentation of the patient should be made if fever, nausea, vomiting, abdominal pain, visual disturbances or seizures occur. These symptoms could indicate increased pressure in the brain or a severe infection.

In addition, every patient should receive an ID card that contains all information regarding the shunt and on which the controls and any changes made can be entered.

The following topics could also be of interest to you: