Know Your Neurosurgeon

Child Procedures

The commonest neurosurgical condition in children, aside from trauma, is hydrocephalus (water on the brain) or CSF flow disturbances.

Causes

The causes of hydrocephalus and CSF flow disturbances are not exhaustive but may include tumour, trauma, infection, vascular accidents, congenital or toxic. The end result of each is a build up of CSF within the central nervous system (including the spinal cord). This is akin to having a mountain lake, which had been draining down a small stream, suddenly having the same stream blocked or having backflow from a downstream reservoir. Fluid within the lake has to be diverted in some manner.

Possible Diversions
  • Temporarily via an external drainage outside the head (external ventricular drain)
  • Analogy of temporary piping draining the lake into tankers
  • Permanently with an internalized shunt which drains CSF into the abdomen, chest cavity, heart or another chamber
  • Analogy of pipes diverting the lake into another lake or flowing river
  • Permanently with a third ventirculostomy or another form of endosotomy
  • Analogy of digging a new river carrying the lake water into another lake or flowing river
  • Medically or surgically reducing the production of CSF (rarely used)
  • Drying the lake up

At Lac-con Neurosurgery, all these techniques may be employed to deal with hydrocephalus.

Further Treatment

Irrespective of the approach used, once surgery has been undertaken to treat hydrocephalus, the patient must be regarded as having hydrocephalus even if a permanent shunt was not inserted. Any such technique may fail and this failure will result in headaches, vomiting and drowsiness and/or cognitive decline and gait disturbance. The presence of these symptoms must be regarded as a shunt or diversion failure unless proven otherwise. In the absence of other symptoms, this clinical picture will require urgent neurosurgical review or surgery. Build-up of intracranial pressure will result in brain damage, blindness or death unless urgent neurosurgical management is obtained.
 

Please discuss with your surgeon the risks and benefits of each option.

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