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Treatment of hydrocephalus at the Wessex Neurological Centre Mr Ryan Waters PhD FRCS (Neuro Surg) Consultant Neurosurgeon.

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Presentation on theme: "Treatment of hydrocephalus at the Wessex Neurological Centre Mr Ryan Waters PhD FRCS (Neuro Surg) Consultant Neurosurgeon."— Presentation transcript:

1 Treatment of hydrocephalus at the Wessex Neurological Centre Mr Ryan Waters PhD FRCS (Neuro Surg) Consultant Neurosurgeon

2 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

3 Southampton Staff Owen Sparrow Nijaguna Mathad Aabir Chakraborty Ryan Waters Christine Ward (Nurse practitioner) 13 Paediatric Neurosciences nurses Peter Gladwell (Surgical Practitioner)

4 Hydrocephalus “An abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain” but not the whole story?

5 Classification Non-communicating/obstructive –CSF flow obstruction –Aqueduct stenosis –Tumour –Haemorrhage Communicating –Absorption problem –Haemorrhage –Infection –Tumour –Inflammation –‘normal pressure hydrocephalus’ –IIH

6 Common causes of hydrocephalus

7 Causes Post head injury Tumour

8 Is the child Unwell? –Vomiting –Drowsiness –Headaches –School performance –Head circumference –Fontanelle –Bradycardia/apnoeas –Squint –Sunsetting

9 Treatment options Treat the underlying cause Temporary CSF drainage –Lumbar puncture –Ventricular tap –EVD Endoscopic IIIrd ventriculostomy Shunt –VP –VA –VPleural

10 ETV

11 Shunt

12 Shunt hardware

13 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

14 Shunt Blockage Southampton Children's Hospital

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16 Shunt Disconnection Southampton Children's Hospital

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18 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 Reservoir Southampton Children's Hospital

19 Normal Pressure Hydrocephalus Generally seen in older adults Communicating hydrocephalus Clinical triad –Cognitive decline –Gait disturbance –Urinary incontinence Ventriculomegaly on imaging

20 Investigation at WNC MDT with neurology, neuropsychology, neurosurgery Assessment –Neuropsychology –Walking test –CSF infusion test –CSF drainage

21 Treatment at WNC VP shunt –Programmable valve –Risk of overdrainage and subdural formation

22 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


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