Presentation is loading. Please wait.

Presentation is loading. Please wait.

Treatment of hydrocephalus at the Wessex Neurological Centre

Similar presentations

Presentation on theme: "Treatment of hydrocephalus at the Wessex Neurological Centre"— 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 Patient Assessment-History & Examination
Is the child Unwell? Vomiting Drowsiness Headaches School performance Head circumference Fontanelle Bradycardia/apnoeas Squint Sunsetting 8

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 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 13

14 Shunt Blockage Southampton Children's Hospital

15 Shunt Malfunction 15

16 Shunt Disconnection Southampton Children's Hospital

17 Southampton Children's Hospital

18 NB Facilitated by System with Reservoir
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

Download ppt "Treatment of hydrocephalus at the Wessex Neurological Centre"

Similar presentations

Ads by Google