Turbine oils. General requirements and properties

Hydrocephalus is a life-threatening disease. It provokes an excess of the permissible level of fluid accumulation - cerebrospinal fluid, which leads to pressure on the brain tissue.

Due to the impossibility of finding an outflow path, the cerebrospinal fluid becomes a provocateur of intracranial pressure, which is a direct threat to brain compression.

Hydrocephalus in most cases is a congenital disease, but the possibility of its manifestation both in early childhood as well as in adults.

A possible and practically the only way to get rid of severe symptoms of the disease is surgical intervention - shunting.

What is shunting for cerebral hydrocephalus

The operation got its name from the word shunt , denoting bypass. That is, with the help of a kind of inert silicone tube (hose, catheter), an opportunity is created for the outflow of cerebrospinal fluid from the brain system or to equalize the imbalance in its formation and output.

Ventriculoperitoneal shunting is recognized as the most common way to eliminate problems with hydrocephalus. It allows you to create a bypass option for removing CSF from the ventricular system of the patient's brain.

In the arsenal of doctors there are more than two hundred various kinds shunt systems. the main objective operations - remove the cerebrospinal fluid from the dilated ventricles to another place: into the abdominal cavity, chest or bladder, from where it will be easier to remove with the help of valves and tubes.

Systems are selected individually for each patient, taking into account the observed pressure to achieve positive results in resisting the disease. The fact is that if the system is chosen incorrectly, an excessive or insufficient current of the cerebrospinal fluid may occur.

Modern technologies offer perfect shunt systems with special devices in the shunt valve. With their help, the necessary level of excretion of accumulated fluid is monitored, which leads to stabilization of intracranial pressure and alleviates the patient's condition.

Throughout the entire postoperative period in the clinic, the selection of the desired level of CSF excretion is carried out under the supervision of specialists. In the event of a malfunction in the system, the patient should contact the attending physician.

Such operations in about 85% give positive results. However, it should be noted that almost half of the operated patients may experience complications in the period from 6 months to a year after bypass surgery. In this case, a second operation may be performed to replace the shunt or its valves.

It is important to know that many patients who have undergone this type of surgery will need to undergo more than one similar operation due to wear and tear of the material and the emergence of newer models. And the quality of their life will be directly related to the quality of functioning of the installed shunt system.

Indications for surgery

There are many factors that disrupt the outflow of fluid from the brain. Among them:

transferred craniocerebral injury– TBI;
cancer brain;
intracranial hemorrhages;
neuroinfections;
failure blood circulation in the vessels of the brain;
deep prematurity;
injury child during childbirth;
anomalies central nervous system.

Such phenomena can provoke a severe pathology, which leads to a violation of the normal correspondence between the produced and removed fluid.

Indications for surgery are based on an adequate diagnosis.

Thus, the diagnosis of congenital hydrocephalus is possible already on the basis of an antenatal ultrasound examination. But this disease is also detected at an early age during medical observation of the development of the child, as well as in the presence of certain symptoms in adults.

When examining patients, the doctor must take into account their age and symptoms of the disease.

If an infant has an excessively large head, a bulge of the fontanel, repeated vomiting, restless behavior, loud crying, convulsive convulsions, a change in the shape of the face, and he lags behind in development, this may indicate that he has cerebral dropsy.

In preschoolers and school-age children, these signs are somewhat different. Children complain of pain in the head. Perhaps a manifestation of weakness, difficulty in remembering, slow development.

Elderly people are characterized by such signs as confusion, impaired coordination of movements, slowness of thinking. The symptoms listed above are not excluded.

When examining a child or an adult with suspected this disease, not only physical and neurological parameters are taken into account, but also CT and MRI data, the results of which give an idea of the violation of processes in the brain.

If the diagnosis of hydrocephalus is confirmed during the examination on these devices, the patient is recommended to have a brain bypass. The leading role in determining the indications for surgery is given to the opinion of the neurosurgeon.

Kinds

When a diagnosis of the presence of hydrocephalus is established, the operation is performed using a shunt in the form of a hollow tube, through which excess fluid will subsequently be removed.

Depending on the indications, neurosurgeons select the most effective for a given clinical case type of operation. Possible options for shunting:

ventriculoperitoneal- diversion of fluid flow into the abdominal cavity;
ventriculoatrial- in the right atrium;
ventriculopleural- in the pleural cavity;
used as a place for liquid drainage bilious or the bladder if the previously mentioned cavities cannot be used.

The choice of one of the types of shunting depends on the indications for each individual, the state of his physical health.

Shunting methods

Due to the fact that hydrocephalus of the brain is not cured by a therapeutic method, for a long time, operations using a shunt - shunting remain the traditional way.

The action of the implanted shunt is aimed at bringing cerebrospinal fluid into one or another cavity of the body (abdomen, atrium, pleura, bladder or gallbladder) and ensuring the normalization of intracranial pressure.

When using this method, a system of catheters and valves is inserted into the abdominal (or other) cavity in order to divert the cerebrospinal fluid in the right direction and reduce pressure in the head.

This method is characterized by only one drawback - this is a small length of the catheter. In addition, it can become clogged or bent, which is why the shunt will have to be changed. This procedure is urgent and provides for the immediate appeal of the patient to specialists.

Equally important in the system itself is the state of the valve, which is able to regulate the filling level of the tank. Convenient three modes bandwidth shunt, carried out by modern valves - high, medium and low.

But preference in recent times given to models with a special program that diverts the current of the cerebrospinal fluid as the permissible norms are exceeded.

Shunting does not make it possible to completely get rid of the disease. But thanks to the operation, negative symptoms are excluded, and the patient can lead a normal life, if he does not neglect the advice on monitoring the condition of the shunt.

The most progressive and less traumatic for dropsy of the brain is the neuroendoscopic method. It is used less often because of the expensive system.

An endoscopic operation is performed with this diagnosis within half an hour, in contrast to bypass surgery, which is performed within one or even two hours.

It goes in the following order:

injected into the valves of the brain neuroendoscope with mini camera;
camera transmits picture on the screen, which allows doctors to see where to insert the system to drain the fluid;
removal excess CSF is produced through the bottom of the third ventricle using a catheter.

This method enables a person to avoid repeated bypass operations, as it ensures constant normalization of the CSF system.

But it should be noted that the possibility of using endoscopic surgery for hydrocephalus is not possible for all manifestations of the disease. That is why shunting using implant shunts is recognized as the main way to deal with it.

results

Shunting for hydrocephalus of the brain makes it possible not only to save a large number of human lives, but also returns to patients a sense of fullness.

However, it is necessary to be aware that the consequences may not always be predictable due to the fact that the brain is an extremely complex structure. But the likelihood of unwanted side effects is no higher than with any surgical intervention.

Possible side effects include the reluctance of the shunt or its valves to become part of the human body. Sometimes there is epilepsy, blood clots in the shunt, or a stroke.

At the same time, liquor shunting in 85 percent gives only positive results, as evidenced by the grateful reviews of people who received the opportunity to enjoy life after the operation.

In order to avoid the occurrence of complications in the postoperative period, it is necessary to immediately consult a doctor at the first signal of the body about deviations in well-being.

Positive results after brain bypass surgery largely depend on the behavior of the patient and the people around him.

The risks associated with shunt implantation are high and do not cure hydrocephalus. However, under no pretext should this procedure be delayed if it is recommended by doctors, as this can lead to irreversible processes and even death.

Possible side effects are outweighed by the results of the patient's quality of life after surgery. And although hydrocephalus does not recede forever and completely, one cannot help but use the opportunity to eliminate the risk of death and dull the symptoms of the disease. This is the main purpose of shunting.

Surgical treatment of pathologies such as complex system The body, like the brain, is usually associated with high risk and high complexity of execution. Dropsy of the brain, a disorder that has a different etiology and affects all age groups. Most often, this disease is a consequence of intrauterine development disorders and newborn children become its victims. Brain shunting for hydrocephalus can improve the quality of life of adult patients and restore the normal development of children.

The mechanism of formation of hydrocephalus

Hydrocephalus is a pathology accompanied by the formation of an excessive accumulation of cerebrospinal fluid in the skull. Cerebrospinal fluid (CSF) is the result of the secretory activity of the glands of the brain, and serves as a kind of nutrient solution and water cushion that protects the brain and spinal cord. In a normal state, CSF, produced in a volume of about 450-600 ml per day, is redistributed between the cranium and spinal cord, and subsequently enters the vascular system, being distributed throughout the body.

To ensure constant circulation of the cerebrospinal fluid system, the volume of produced cerebrospinal fluid must be completely removed, maintaining hydrodynamic balance. Physiological disorders that impede the normal circulation of cerebrospinal fluid lead to the formation of hydrocephalus.

Causes of hydrocephalus development

The cause of the development of hydrocephalus syndrome in a newborn child is infectious diseases of the mother, transferred during the period of gestation:

rubella;
cytomegalovirus infection;
syphilis;
toxoplasmosis.

Acquired hydrocephalus is often the result of:

inflammatory process in the tissues of the pia mater of the brain (meningitis), which is responsible for the timely removal of cerebrospinal fluid;
previous head injuries;
intracranial hematomas;
the development of neoplasms that deformed the circulation paths of the cerebrospinal fluid system.

Symptoms of hydrocephalus

Symptoms of the development of hydrocephalus have differences in different age categories. So, for example, symptoms of dropsy of the brain in a newborn baby are:

disproportionately large head;
intensive growth of the volume of the skull;
large and prominent fontanel without signs of pulsation;
downward shift of the eyeballs or according to the type of convergent or divergent strabismus.

In adults and physiologically formed children, the following symptoms are observed:

severe headaches;
visual impairment;
neurological disorders;
mental disorders;
memory loss.

Need to know: hydrocephalus in children, unlike adults, does not cause significant physical discomfort, due to the flexibility of the skull, but it obviously causes developmental delay.

Shunting of the CSF system

Surgical intervention to remove excess cerebrospinal fluid is called shunting and is performed in cases where conservative treatment methods are not effective or it is not possible to identify the pathology that caused these disorders.

Shunting is an artificial creation of fluid outflow pathways by installing a system of thin polymer hoses. Depending on where the liquor will be removed, there are the following types bypass:

with the removal of shunts into the abdominal cavity;
bladder;
pleural cavity;
into the cavity of the heart sac.

The technique of setting shunts also depends on the reasons that caused the imbalance in the work of the CSF system:

lack of regulation of the production of cerebrospinal fluid (excessive production);
violations of the mechanism of removal of cerebrospinal fluid by the vascular system due to atrophy of the arachnoid membrane of the brain;
malformations of the cerebrospinal fluid outflow tract.

In some cases, to normalize blood circulation, shunting of cerebral vessels is required.

You should know: despite the effectiveness of bypass surgery, they eliminate only the symptoms and manifestations of the disease, and are not able to restore existing disorders.

CSF bypass technique

Surgical intervention to install a CSF bypass system is performed under general anesthesia. Depending on the type of shunting, the final fragment of the drainage tube is installed in the abdominal, pleural cavity or atrium. Usually, the atrial region is preferred, as a shorter catheter is used in this case, which reduces the likelihood of complications.

At the next stage, the drainage system is laid in soft tissues, trying to synchronize the path of the tube with the leading arteries. At the last stage, a brain shunt is installed in the corresponding ventricle (one or more, depending on the development of the pathology) through a burr hole in the skull.

Possible complications after surgery

Operations to bypass the CSF system in children, in 50% of cases, are accompanied by complications arising from changes in the body during the growth process. Most often, several operations are required to replace, restore or correct system fragments. After the shunt is installed, the growth and development of the child is completely dependent on his work.

In adult patients, the need to replace the shunt arises mainly when it is mechanically damaged.

The most likely complications after CSF bypass surgery are:

blockage of the conducting system at any level;
infection of the body during the operation;
formation of an intracranial hematoma;
bending or curvature of the shunt;
excessive removal of fluid from the cavities of the brain (hyperdrainage);
insufficient drainage of fluid from the cavities of the brain (hypodrainage);
damage to brain tissue during surgery;
the appearance of signs of epilepsy, due to the reaction of the body to a foreign body in the brain tissues.

You should know: all modern shunt systems are equipped with valves designed to maintain normal intracranial pressure and prevent backflow of fluid.

Despite the complexity of the operation, further forecasts are usually quite optimistic. The shunt system, being, in fact, a prosthesis that replaces the natural CSF pathways, allows you to avoid life-threatening conditions, improve the quality of life, and in some cases achieve a complete cure.

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Shunting of cerebral vessels is an important procedure that allows you to normalize blood circulation and all metabolic processes that occur in the human brain. It is a necessity for hydrocephalus, when it is necessary to ensure the normal functioning of all components of the head and remove excess cerebrospinal fluid. Modern surgery makes it possible to carry out appropriate operations as quickly as possible and with minimal risks.

Features of hydrocephalus

This disease is also called "dropsy of the brain." The reason for its development is the accumulation of cerebrospinal fluid in the ventricles of the brain. During normal functioning, this fluid provides intracranial tissues with protection from all kinds of mechanical damage and supports metabolic processes. If the disease is occlusive, then the problem is the inability to move the fluid to the site of absorption. If non-occlusive - in adsorption failures.

As a result of violations, when the fluid is sent to the ventricle, pressure on the walls of the brain increases, neurological problems develop. The pathology itself, as a rule, is a balance failure in the production and adsorption of CSF fluid in the ventricular system, causing problems with all metabolic processes.

Various stenoses, craniovertebral anomalies, intrauterine infections, birth injuries, craniocerebral injuries, inflammation, vascular disorders, tumors, cysts, atherosclerosis, hypertension, and diabetes can cause problems with the ventricles and cerebrospinal fluid exchange.

In the absence of proper treatment, such a deviation leads to death.

Symptoms

The disease can be either congenital or acquired. Even newborns often face it. Premature babies are most at risk of getting this problem. Symptoms depend on age. If we talk about adults and strengthened children, they may experience the following:

vision and hearing problems;
headaches;
mental and neurological disorders;
memory impairment;
feeling of intoxication.

Babies are not subject to physical discomfort. This is due to the fact that the children's skull has not yet had time to completely ossify. You can identify the disease in infants by the following signs:

disproportionate large skull;
rapid growth of the head;
enlarged non-pulsating fontanel;
downward displacement of the eyeballs or strabismus.

These symptoms require a mandatory examination by a qualified doctor. It is impossible to delay a visit to the doctor.

There is a rare type of hydrocephalus - normotensive. It is detected only in 0.4% of patients. Its peculiarity is the imbalance of secretion, resorption of cerebrospinal fluid, combined with impaired liquor dynamics. The cause of its development is often head trauma, brain damage, the consequences of operations, vascular aneurysms, and tumors. Symptoms are as follows: impaired walking, urinary incontinence, decreased intellectual abilities against the background of a sharp drop in brain activity.

Brain shunt

Brain shunting for hydrocephalus is a strictly mandatory procedure to compensate for the disease. After the successful completion of the operation, improvements will gradually begin to be observed. Within a few days, blood circulation and the outflow of cerebrospinal fluid are normalized, and all brain processes will begin to fully function.

Shunting is also performed when a tumor is detected, atherosclerotic lesions, an imminent unavoidable stroke, stenosis, dangerous changes in the arteries, and violations of venous blood flow inside the head.

Shunt and working principle

Head shunting is performed for hydrocephalus using special shunts. They are hollow tubes through which an excess amount of CSF will be discharged into the selected body cavity for future absorption in a natural way. There are three types of shunting:

Ventriculoperitoneal - the most popular type that sends cerebrospinal fluid to the abdominal cavity;
Ventriculopleural - a type in which fluid is discharged into the patient's chest;
Ventriculoatrial - a rarely used type of shunting, when the CSF enters one of the chambers of the heart.

The shunt system consists of three components. The inner part is represented by a flexible tube made of silicone. It is a kind of catheter. It is installed inside the ventricle, where the cerebrospinal fluid has accumulated. A valve is attached to the catheter, which allows you to adjust the amount of fluid passed in order to eliminate possible risks. Passing through the valve, the excess enters the second part of the system - the reservoir. In it, the cerebrospinal fluid is retained for some time, after which it is sent to the outer section of the shunt, through which the liquid is poured into the selected cavity. A segment of this part of the system is installed under the skin, which makes it invisible to prying eyes.

The valve that regulates the volume of cerebrospinal fluid can be fixed and programmable. In the first case, there are three modes of fluid transmission, each of which has a different work intensity. Programmable also allows you to adjust the level of throughput of the valve as needed. As a rule, when shunting is done for hydrocephalus in young children, they are first given a fixed valve, and only then they are replaced with a programmable one. Adults immediately put the second type.

In rare cases, if there are no other options, the fluid is drained into the bladder or gallbladder.

Preparation for the procedure

When it comes to adults, brain bypass for hydrocephalus requires special preparation. You should start preparing your body for the operation in advance. But you will also need to undergo a large number of examinations to make sure that there are no contraindications and the accuracy of the diagnosis made by the doctor.

The attending physician may prescribe several examinations at once, each of which must be completed in without fail. Among them:

Delivery of blood and urine tests, fluorography, ECG - standard procedures to identify violations of body systems;
Angiography (intra-arterial, or computed tomography) - allows, if necessary, to accurately determine the location of arterial constrictions;
Ultrasound scanning - gives accurate data on the state of all vessels in the body, including cranial ones;
The study of occlusions using a balloon - this is how the body's reaction to the cessation of blood flow through certain arteries is checked.

Additional procedures may also be prescribed that will check one or another body system. This is very important, because The success of the operation depends on many factors.

When a head bypass is due, you should start preparing yourself for a future procedure. If this is not done, there is a risk of serious complications that will have an extremely negative impact on the viability of the body. It is important to do the following:

Stop drinking alcohol and smoking 14 days before surgery.
Stop taking any non-steroidal medicines that have an anti-inflammatory effect.

These two points are mandatory in absolutely all cases. At the discretion of the doctor, additional measures for preparation may be prescribed. And before the operation, the patient will shave off the hair in the treated area.

Features of rehabilitation

When the procedure is completed and the shunt is in the head, the patient will begin to feel unwell. Often it is accompanied by mild nausea, dizziness, headache of varying intensity, slight numbness of the extremities. All these sensations can be expressed with different strengths. This is the norm.

On the second day after the operation, the doctor should evaluate the success of the bypass. To do this, the patient needs to undergo an MRI, which will help check the state of the brain and exclude the possibility of complications after the intervention. If everything is in order, then repeated examinations are carried out in a week and immediately upon discharge from the hospital. Total time recovery in the hospital is 14 days.

The appearance of a person after the installation of a shunt will be normal, because. all its components are almost invisible.

The rehabilitation process

After discharge from the hospital, a person must lead a special lifestyle that will allow him to restore his body as correctly as possible after the operation. The installation of the shunt itself requires special attention, because. many factors can contribute Negative influence on the future state of a person and cause complications.

The convalescent is required to follow simple rules:

Complete rejection of alcohol and cigarettes until the body is fully restored.
Exclusion of any physical activity. A complete ban on lifting weights and all kinds of home or country work.
Refusal to drive a car and all types of work that require concentration. There is a risk of inadequate response to stressful situations, which will also lead to complications.
Home mode for 30 days. At the same time, it is forbidden to visit pools and reservoirs, to be outside for longer than the required time, especially if the weather conditions seem unfavorable.
Lack of touching the head in the area of the postoperative opening. Any contact with this area can cause injury and rapid infection. It is also forbidden to try to remove the shunt yourself.
Take all prescribed medications as directed by your doctor. The patient is prescribed anticonvulsants. At the same time, it is important to monitor your well-being, because. they have a number of side effects.

Throughout the rehabilitation period, it is very important to strictly follow the instructions of your doctor. This is the only way to avoid problems in the future and return to normal life as quickly as possible. The patient will live a full life for a very long time with virtually no restrictions. The life expectancy of those who had to be shunted practically does not differ from the average statistical indicators of healthy people.

It is very important to work on yourself, setting yourself up psychologically for a quick recovery. Rehabilitation without this will be less successful.

The need to replace the shunt

The need for a shunt remains forever. Therefore, the shunt dependent should take his problem as seriously as possible. This is not as convenient as most patients would like, but the result with the ability to live in peace is much more important.

The shunt needs to be changed from time to time. Gradually it loses its effectiveness. The reason for this is blockage, wear, various accidental damage. It is impossible to say how long the shunt will last. They are designed for a service life of up to 10 years. However, often they have to be changed much earlier, regardless of quality. Especially when it comes to children. Together with their gradual growth, lengthening and a shunt will be required. The replacement is very quick and painless.

If you need to check the equipment or replace it in the first place, you should immediately contact your doctor, because. expert intervention will be necessary. It can only be removed by an experienced employee of a medical institution.

Is the patient considered disabled?

Patients who have undergone brain bypass surgery may be eligible for a degree of disability. This is determined by the commission, which makes a decision based on the research. Both a child and an adult can be recognized as disabled if they have violations of the main categories of life activity, which include the following abilities:

self-service;
orientation in space;
movement;
education;
self-control;
communication;
labor activity.

Disability will need to be constantly confirmed on examinations.

Possible Complications

Any operation is always associated with possible risks. During the procedure, a small hole is made in the patient's head, which increases the risk of various complications in the future. It is very important to monitor your condition and visit a doctor regularly, and if you notice a noticeable deterioration in well-being, immediately call an ambulance.

Hydrocephalus and shunting can lead to several complications. They are very dangerous and can be fatal. Therefore, you need to be as careful as possible. What can the patient expect during the recovery period:

infection;
cerebral hemorrhage, stroke;
blockage of blood vessels, the appearance of blood clots;
brain injury, epilepsy;
shunt damage;
improper operation of the shunt with excessive or insufficient intensity of CSF removal;
no effect after shunting.

Many problems can be caused by the fault of doctors, but in 90% of cases, the patients themselves are responsible for the development of complications. The first two weeks are especially important and dangerous, because of which the patient is obliged to stay only in the hospital all this time.

If you follow the doctor's instructions, then the risk of complications is reduced several times, and the prognosis for recovery is extremely positive.

If the patient feels a significant deterioration in well-being, then it is necessary to go to the hospital. This must be done as quickly as possible to eliminate the risk of serious complications. You need to visit a doctor if:

there was an allergy (even skin) from taking the medicines prescribed by the doctor;
gait has changed, there is weakness in the limbs or drowsiness;
increased body temperature up to 38 ° C;
consciousness began to get confused, a constant headache with nausea appeared.

In extreme cases, when the state of health has become very bad or tolerable, but it is impossible to go to the doctor that day, you should call an ambulance.

Conclusion

Brain shunting for a disease such as hydrocephalus is a necessary procedure that allows a sick person to maintain their health. You need to treat it with the utmost seriousness, and after the operation, follow all the requirements and recommendations of the doctor. Hydrocephalus will soon be forgotten, and the shunt itself will become habitual, so there is nothing to worry about. A shunted person lives the same life as everyone else.

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Brain bypass surgery in children, adults and newborns: consequences

Hydrocephalus is a serious condition in which the outflow of cerebral fluid from the ventricles of the brain is impaired. As a result, fluid accumulates in them, causing an increase in intracranial pressure, compression of brain structures, and neurological disorders.

In children with congenital hydrocephalus, the head increases in size, the normal development of the brain in such conditions is impossible. The only way The treatment of this pathology is surgical.

Bypass surgery is an operation that allows you to cure hydrocephalus and prevent its development in the future. Its purpose is to create an additional pathway for the outflow of cerebral fluid from the ventricles when its normal circulation is difficult or completely impossible.

There are several methods of brain shunting:

Ventriculo-atrial (connection of the ventricle with the right atrium, less often with the left one);
Ventriculo-peritoneal (connection of the ventricle with the peritoneum);
Ventriculo-cisternostomy (connection of the ventricle with the cisterns of the arachnoid membrane of the brain);
Subduro-peritoneal (connection of the space under the dura with the peritoneum);
ventriculo-pleural;
Ventriculo-urethral (a rare type of shunting, connection of the ventricle with the urethra).

Which method will be applied in each case depends on:

concomitant diseases;
general condition.

Put your brain to work! After 3 days, memory cardinally ... "

During a brain bypass operation, a system of tubes and valves is inserted into the patient to ensure normal outflow of CSF.

These tubes are further:

do not impede movement;
do not disturb the blood flow;

In adults, they are installed on an ongoing basis; in children, they require periodic replacement as the child grows.

In newborns, such an operation, if indicated, should be carried out as early as possible. This is due to the fact that with congenital hydrocephalus, the development of the brain is disrupted, which leads to deviations in the psyche and mental development of the child.

In older children and adults, hydrocephalus can usually be caused by previous encephalitis or meningitis, so one ventricle is most often affected. This makes the operation itself easier, but lengthens the diagnosis, because it is necessary to find out in which particular ventricle the violation occurred.

Shunting normalizes the outflow of cerebrospinal fluid from the ventricles of the brain, due to this, intracranial pressure also normalizes, which allows you to get rid of headaches.

The crowded ventricle stops squeezing neighboring brain structures, so the neurological disorders caused by hydrocephalus disappear, and lost motor functions are restored.

In newborns, due to the peculiarities of physiology, overflow of the ventricles causes an increase in the head in size, accompanied by compression and atrophy of the brain.

In the future, this threatens with mental retardation and severe motor impairment in the child.

Timely shunting allows you to stop this process. The children's brain is very plastic, and the functions of the damaged areas of the brain are quickly restored, the pace of development of the child is gradually catching up with healthy children of the same age.

As for the cosmetic effect, here, unfortunately, there is no reverse development, but as the child grows, the proportions of his body can return to normal.

Before performing bypass surgery:

The patient will be scheduled for a series of tests. Ventricular abnormalities, fluid accumulation, and brain damage are primarily seen on MRI. This study allows you to get the most complete picture of CSF outflow disorders in the ventricles, and based on its results, the question of the need for surgery is decided.
Other studies - angiography of the brain (X-ray examination of blood vessels, can be performed together with MRI or CT) to identify possible blood flow disorders in the brain, the risk of bleeding during surgery, and the location of the vessels.
Additionally, a study of the cavity into which it is planned to withdraw the cerebral fluid is carried out. If the atrium is chosen as this, it is necessary to do an ECG, echocardiography, dopplerography of the heart to determine how safe such an operation is.
If it is planned to connect the affected ventricle to the peritoneum, then ultrasound and MRI of the abdominal cavity are performed to identify possible contraindications to the operation.

If the operation is already scheduled, then the patient must:

Take a shower twice - on the evening before the operation and in the morning on the day of the operation, while washing your hair thoroughly.
The last meal should be eight hours before the operation, you can drink water in small quantities, alcohol is completely contraindicated.
Hair on the head must be shaved (this is done by a nurse) completely or partially.
It is necessary to remove glasses, contact lenses, dentures, earrings and piercings - there should be no foreign objects on the head during the operation.
All decorations mobile phone and other valuables must be given to relatives in advance or handed over to the storage room.

The price of the operation varies depending on the region and on the characteristics of the clinic, but we can say for sure that bypass surgery is not a cheap pleasure. In addition to the operation itself, you will have to spend money on diagnostic procedures, which also cost a lot.

The first day of the postoperative period, the patient spends in neurocritical care. This is necessary in order to ensure the most careful monitoring of the patient and notice the deterioration in time, if it happens. If necessary, the period of stay in intensive care is extended.

If the postoperative period proceeds without complications, then a day after the operation, the patient is transferred to the neurological department.

In the next week after the operation, the patient is shown bed rest with its gradual expansion as the patient's well-being improves. During this period, the patient is prescribed antibiotics as a prevention of infection.

Other medicines are also prescribed:

anticonvulsants;
painkillers;

After the operation, the patient is given an MRI - the first time a day after the operation, if necessary, the analysis can be ordered again. You need to make sure that the shunt is in place, located freely and performing its function.

After discharge from the hospital:

Such strict restrictions are maintained for a month or more, if necessary. Over time, the patient returns to a full healthy life.

As with any operation, especially on the brain, there are a number of complications with bypass surgery, so it is very important not to miss their first symptoms.

Symptoms of various complications:

- headaches;
- nausea and vomiting;
- scar redness;
- fast fatigue.
Incorrect installation of the shunt leads to the fact that the symptoms of hydrocephalus do not go away after the operation, in addition, signs of inflammation appear - pain along the shunt, fever, and edema. In order to prevent this, an MRI is performed after the operation.
A complication that usually occurs a few years after surgery is clogging of the shunt. It is manifested by the return of symptoms of hydrocephalus - headaches, focal neurological symptoms, increased intracranial pressure.

In order to notice the first signs of shunt clogging in time, it is necessary to visit a neurologist every year. If such a pathology occurs, the clogged shunt is removed and replaced with a new one.

Brain shunting is a type of surgical (surgical) treatment of diseases of the brain and their consequences, vascular and cerebrospinal fluid systems. The method is based on the mechanical restoration of blood or cerebrospinal fluid circulation by connecting vessels or other brain structures to each other.

The nervous system is a very complex mechanism in the human body, interconnected with other systems. Like other organs and tissues, the brain needs nutrition and oxygen. All this he gets thanks to the cardiovascular system. The brain is washed by 4 large arteries, and stenosis (narrowing of the lumen of the vessel) or occlusion (complete obstruction) cause a significant disruption of the functions of the nervous system as a whole. Such problems can be acute and occur once with pronounced symptoms, posing a significant threat to human life and health, or chronic.

If the trophism (nutrition) of the brain is constantly disturbed and the symptoms increase, this can lead to the following irreversible changes:

death of nerve cells;
disability of the patient;
death in severe form.

The vascular system of the brain is represented by four large arteries: the right and left carotid arteries, the right and left vertebral arteries. With stenosis of any of them, the patient has focal symptoms, depending on the location of the lesion.

Cerebral vascular shunting is a method of surgical treatment, the purpose of which is to improve or restore the blood supply to the brain, thereby its full functioning.

The therapeutic effect is achieved due to the establishment of a shunt-anastomosis between the passable and stenotic vessels and the redistribution of blood between different parts of the organ.

The brain is at the head of the central nervous system. In a fraction of a second, many different processes take place in it, on which the vital activity of the whole organism depends.

In order for it to fully function, it needs adequate nutrition, which is provided by the blood. However, blood is not only a source of nutrition. It carries away decay products from the brain.

In modern medicine, 2 types of shunting are practiced: an autodonor shunt and a shunt from the arteries of the scalp. A suitable option is chosen based on a number of parameters (the required blood flow rate, the state of the patient's cardiovascular system as a whole, the presence of concomitant diseases) and for each patient individually.

In autodonor shunting, a vessel is taken from the patient, usually from the radial or ulnar artery of the arm or part of the great saphenous vein of the leg. One end of the taken vessel is sutured to the external carotid artery, then passed subcutaneously and sutured through a previously prepared trepanation window to the clogged vessel above the site of stenosis. This option is used for the main arteries with high speed blood flow. For smaller vessels, through which blood circulates at a lower intensity, shunts are used from the vessels of the soft tissues of the head (scalp). This method is less traumatic, due to the smaller volume of surgical intervention.

Only one end of the selected vessel is isolated, passed through the trepanation window and sutured to a small vessel on the surface of the brain. After the operation, the blood supply to the brain improves.

Brain shunting in hydrocephalus has a number of features, since it redistributes not the blood in the vessels, but the cerebrospinal fluid.

Hydrocephalus is a severe pathology, a characteristic feature of which is an increase in the brain regions of the skull due to excessive accumulation of cerebrospinal fluid (CSF) in the cavities and a violation of its discharge.

Epidemiology of hydrocephalus. Regardless of the etiological factors, congenital hydrocephalus occurs in two newborns out of 1000. If the child is not operated on in time, the mortality rate is 75% in the first year of life.

This disease affects both newborns and adults, while it has various causes (infectious diseases in the mother during pregnancy, birth trauma, the consequences of meningitis, congenital malformations, traumatic brain injury, arachnoiditis, cysts and tumors of the nervous system).

Hydrocephalus is a dangerous disease. Regardless of the etiology, it has a high percentage of mortality and disability among newborns. On the this stage development of medicine, shunting is the only effective method of treating hydrocephalus, despite the high percentage of complications, among which are:

infection of the body cavities depending on the location of the shunt;
development of epilepsy;
inadequacy of the drainage system itself, namely, insufficient or excessive outflow of cerebrospinal fluid.

Features of such operations in newborns with hydrocephalus, in addition to the risk of complications, include the need for repeated operations.

In the first year of life, a newborn grows very quickly, and over time, the shunt ceases to cope with its functions, in addition, as the child grows, the shunt can shift, which threatens to damage the brain and its structures. Hydrocephalus requires treatment in dynamics.

The main purpose of shunting in hydrocephalus is the redistribution of cerebrospinal fluid in the ventricular system of the brain.

The main types of bypass for hydrocephalus:

Ventriculoperitoneal shunting.
Ventriculoatrial shunting.

In the first method, a neurosurgeon makes a burr hole in the skull of a newborn, into which he inserts a special tube. Its lower end is inserted into the cavity of the ventricle, and the second end is connected to the abdominal cavity. Excess fluid is absorbed, but the risk of complications is high. The second type is less dangerous in terms of complications. The shunt itself is more complex in its structure, it has a number of valves, on which its reliability and functionality depend. Such a shunt requires replacement every six months, respectively, the next surgical intervention is performed.

In the postoperative period, a patient with hydrocephalus is prescribed painkillers and anticonvulsants, which are selected by the doctor, who also sets the dosage.

As you recover, drug therapy changes depending on the dynamics of the disease.

In case of violation of the normal blood supply and insufficient blood supply to the brain, patients are prescribed surgical intervention according to indications. An operation called cerebral artery bypass surgery restores blood flow in the vessels and arteries. The method is thoroughly studied, has a low level of risk with a high complexity of the operation. It is indicated in the treatment of ischemia, neonatal hydrocephalus, removal of brain tumors, cysts.

Surgical intervention with shunting of cerebral vessels is prescribed by specialists in the following cases:

with atherosclerotic lesions or tumors of the carotid artery;
with aneurysms that cannot be cured by intravascular methods;
if arterial stenosis is diagnosed;
for the treatment of ischemia, removal of cysts and brain tumors;
in the treatment of hydrocephalus in newborns.

Hydrocephalus in newborns is popularly called dropsy of the brain. The disease is characterized by the expansion of the bones of the skull due to a pathological increase in the amount of cerebrospinal fluid in it. Bypass surgery is the only way to achieve a positive result in such a serious disease, although it gives frequent complications with relapses.

It is difficult to predict the consequences of surgical intervention in the brain of newborns, but there are no other methods of treating hydrocephalus yet.

When diagnosing a cyst, a brain tumor by MRI or computed tomography, doctors also decide on bypass surgery, especially if part of the vessels is damaged, prone to inflammatory processes. Thanks to the operation, it is possible to connect the arteries to the vessels, restore the disturbed blood supply.

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Preparation for bypass surgery consists of several ways to examine the brain, blood vessels and arteries. Depending on the diagnosis, doctors prescribe:

Magnetic resonance imaging. The method helps to determine the location of the stenosis, the size of the cyst, tumor.
Computed tomography. The examination reveals lesions of the brain vessels, indicates foci of inflammation, details the size of the cyst, malignant tumor.
Ultrasonic scanning of blood vessels. It is necessary to assess their condition, the degree of damage.
Study of temporary occlusion. It makes it possible to find out what will happen to the brain when blood stops in the studied artery.

In case of hydrocephalus of newborns, the fundus is examined, neurosonography, ultrasound of the brain, computed or magnetic resonance imaging are prescribed.

Preparation for the operation of adult patients begins a month before its date. The patient is forbidden to drink alcohol, smoke, it is recommended to give up other bad habits. The same rule applies to the month of the rehabilitation period. A week before the bypass, a ban on taking NSAIDs is introduced. Also, all necessary urine and blood tests are taken from adults and children, an examination is carried out by a neurosurgeon, a neuropathologist. A prerequisite is the passage of fluorography, the removal of an electrocardiogram.

Surgery to bypass blood vessels and arteries of the brain is performed different ways. It depends on the size, location of the cyst or tumor, the degree of development of hydrocephalus in newborns and children under two years of age.

Any operation involves the complete removal of the cyst, gluing part of the damaged vessels, which cannot be done without craniotomy. Only a neurosurgeon can perform the intervention. Before the start of the operation, a written consent is taken from the patient or his relatives by signing an agreement.

Ventriculo-peritoneal shunting is used to treat neonatal hydrocephalus. Liquor from the ventricles of the brain is discharged through catheters into the body cavity, absorbed between the intestinal loops. The flow rate is controlled by a valve. This method saves thousands of children's lives every year around the world.

It is difficult to predict the consequences of shunting of cerebral vessels. In the presence of a large cyst or tumor during surgery, sometimes there is a blockage in the ventricles or cavity, infection of the meninges. There are also damage to the shunt itself, the formation of bedsores of organs. In the postoperative period, in the treatment of hydrocephalus and tumors, blood clots may appear.

The disadvantages of the method are also the occurrence of strokes, epileptic seizures in the patient. Sometimes lifelong shunt dependence is required, an annual check of the condition of the shunt.

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If the surgery was successful, the patient feels well. There may be complaints of sore throat in the place where the artificial lung ventilation tube was inserted. For some time, the patient may be disturbed by nausea, headache, lack of appetite. This is the normal state. Before discharge, an MRI is performed, duplex scanning to assess the performance of the shunt.

A bypass surgery is an intervention by a surgeon that affects the brain, this procedure is aimed at restoring normal blood flow. An operation on the vessels of the brain can be performed in the form of bypass arteries, this procedure helps to restore the functioning of the blood supply.

The operation is dangerous and complicated, and can also lead to negative consequences, however, there are such diseases where patients are in dire need of bypass surgery, because it will give a guarantee for a full life.

What is it for? The procedure is necessary to eliminate ischemia and hydrocephalus, diseases associated with the vessels and arteries of the brain.

Ischemia occurs when one of the four arteries in the brain malfunctions.

Shunting is necessary if:

The tumors damaged the carotid artery;
The patient suffers from aneurysms that cannot be treated with open techniques;
With the rapid development of coronary disease, which doctors are unable to stop with the help of medical treatment.

In order to prepare for the operation, it is necessary to stop drinking alcohol and smoking 3 weeks before the procedure. tobacco products. If this condition is not met, there is a risk of opening bleeding in the vessels.

Preparation for shunting: wash your hair before the upcoming operation, in some cases, the doctor can shave the operated area, since in this case the operation will be performed faster, better, and most importantly, the risk of infection is reduced several times.

Training

Refusal of alcoholic beverages, smoking two weeks before bypass surgery.
Do not use anti-inflammatory drugs.
Analysis of blood, urine
Make a fluorography
Written consent for bypass surgery

Operation

It is performed under general anesthesia. The patient is covered with sheets, except for the area where the incision will be made. All areas and parts of the body are carefully treated with specialized disinfectants. The catheter is installed and fixed. The doctor cuts the path of the shunt in the subcutaneous tissue and leads to the brain through the hole. Shunting is performed by a neurosurgeon.

Hydrocephalus is a disease characterized by a large accumulation of fluid inside the brain. The causes of the pathology are infections that have been transferred at an early age and transmitted to the child from the mother during pregnancy. Neonatal shunting is used to eliminate hydrocephalus (hydrocephalus) of the brain. There is a high risk of complications.

Drive a car on your own;
Drink strong drinks that contain alcohol, and also refrain from smoking;
Do not put stress on the body in the form of tedious physical work;
It is necessary to be in the fresh air every day;
Strictly follow all doctor's instructions.

Effects

If the patient has a large cyst, blockage of the meninges may occur. There is a risk of stroke, epileptic seizures, or shunt thrombosis.

After a successful operation, there are only minor inconveniences, in the form of nausea, headache, or lack of appetite, all of which are quite normal postoperative manifestations. And it is worth remembering that these symptoms are temporary.

Hydrocephalus- This is a serious condition in which the outflow of cerebral fluid from the ventricles of the brain is impaired. As a result, fluid accumulates in them, causing an increase in intracranial pressure, compression of brain structures, and neurological disorders.

In children with congenital hydrocephalus, the head increases in size, the normal development of the brain in such conditions is impossible. The only way to treat this pathology is surgical.

Shunting- This is an operation that allows you to cure hydrocephalus and prevent its development in the future. Its purpose is to create an additional pathway for the outflow of cerebral fluid from the ventricles when its normal circulation is difficult or completely impossible.

The essence of the operation is that a special tube (shunt) connects the affected ventricle of the brain and the right atrium or peritoneum. Thus, the outflow of fluid is ensured, the ventricle returns to its normal size.

There are several methods of brain shunting:

Ventriculo-atrial(connection of the ventricle with the right atrium, less often with the left one);
ventriculo-peritoneal(connection of the ventricle with the peritoneum);
Ventriculocisternostomy(connection of the ventricle with the cisterns of the arachnoid membrane of the brain);
Subduro-peritoneal(connection of the space under the dura mater with the peritoneum);
Ventriculo-pleural;
Ventriculo-urethral(a rare type of shunting, connection of the ventricle with the urethra).

Which method will be applied in each case depends on:

features of the course of the disease in the patient;
concomitant diseases;
general condition.

How is the operation performed on children, adults and newborns?

During the operation for brain shunting the patient is introduced a system of tubes and valves that ensure the normal outflow of CSF.

These tubes are further:

do not impede movement;
do not disturb the blood flow;
can significantly improve the patient's condition.

At adults they are permanently installed children need to be replaced periodically as the child grows.

In newborns, such an operation, if indicated, should be carried out as early as possible. This is due to the fact that with congenital hydrocephalus, the development of the brain is disrupted, which leads to deviations in the psyche and mental development of the child.

The longer hydrocephalus persists, the less the child's chances for successful rehabilitation in the future. If the operation is carried out at an early age, then it allows the child to develop in the same way as his healthy peers.

In older children and adults, hydrocephalus can usually be caused by a history of encephalitis or meningitis therefore, most often one ventricle is affected. This makes the operation itself easier, but lengthens the diagnosis, because it is necessary to find out in which particular ventricle the violation occurred.

Shunting normalizes the outflow of cerebrospinal fluid from the ventricles of the brain, due to this, intracranial pressure also normalizes, which allows you to get rid of headaches.

A crowded ventricle stops squeezing neighboring brain structures, so the neurological disorders caused by hydrocephalus disappear, are recovering lost motor functions.

In newborns, due to the peculiarities of physiology, ventricular overflow causes head enlargement in size, accompanied by compression and atrophy of the brain.

In the future, this threatens mental retardation and severe motor impairment The child has.

Timely shunting allows stop this process. The children's brain is very plastic, and the functions of the damaged areas of the brain are quickly restored, the pace of development of the child is gradually catching up with healthy children of the same age.

As for the cosmetic effect, here, unfortunately, there is no reverse development, but as the child grows, the proportions of his body can bounce back.

Before performing bypass surgery:

The patient will be scheduled for a series of tests.. Ventricular abnormalities, fluid accumulation, and brain damage are primarily seen on MRI. This study allows you to get the most complete picture of CSF outflow disorders in the ventricles, and based on its results, the question of the need for surgery is decided.
Other studies - angiography brain(X-ray examination of blood vessels, can be performed together with MRI or CT) to identify possible blood flow disorders in the brain, the risk of bleeding during surgery, and the location of the vessels.
Additional research is underway the cavity into which it is planned to withdraw the cerebral fluid. If the atrium is chosen as this, it is necessary to do an ECG, echocardiography, dopplerography of the heart to determine how safe such an operation is.
If you plan to connect the affected ventricle with the peritoneum, then ultrasound and MRI of the abdominal cavity are performed to identify possible contraindications to surgery.

If the operation is already scheduled, then the patient must:

Take a shower twice- on the evening before the operation and in the morning on the day of the operation, be sure to wash your hair thoroughly.
Last meal must be eight hours before surgery, you can drink water in small quantities, alcohol is completely contraindicated.
Hair on the head is necessary shave off(this is done by the nurse) in whole or in part.
Glasses must be removed contact lenses, dentures, earrings and piercings– during the operation, there should be no foreign objects on the head.
All decorations, mobile phone and other valuables must be given to relatives in advance or hand over to the storage room.

Operation price

The price of the operation varies depending on the region and on the characteristics of the clinic, but we can say for sure that bypass surgery is a pleasure. not cheap. In addition to the operation itself, you will have to spend money on diagnostic procedures, which also cost a lot.

In newborns with congenital hydrocephalus, such operations can be done free of charge. Nevertheless, the faster the operation is performed, the more chances the patient has to return to a full healthy life.

Rehabilitation and recovery

The patient spends the first day of the postoperative period in neuroresuscitation. This is necessary in order to ensure the most careful monitoring of the patient and notice the deterioration in time, if it happens. If necessary, the period of stay in intensive care is extended.

If the postoperative period proceeds without complications, then already in a day After the operation, the patient is transferred to the neurological department.

Other medicines are also prescribed:

anticonvulsants;
painkillers;
with high blood pressure - mannitol in combination with other diuretics.

After the operation, the patient is given MRI- the first time a day after the operation, if necessary, the analysis can be ordered again. You need to make sure that the shunt is in place, located freely and performing its function.

After discharge from the hospital:

It is necessary to remain under the supervision of a neurologist for six months.
If during this time there were no complications, then the likelihood of their occurrence in the future is quite low.
Any physical activity, even insignificant, during this period should be agreed with the doctor. The exception to this rule is walking.
Professional sports are excluded until the moment the attending physician decides that it is safe for the patient.

After discharge from the hospital:

You can take a bath, shower and wash your hair - this will not cause complications, but you should not go to the pool and swim in open water.
It is advisable to exclude all possible stresses, stop smoking, completely stop drinking alcohol.
Caffeine won't help either.
Housework, like any physical activity, must be strictly dosed, you can not lift heavy objects.

Such strict restrictions remain for a month or more, if necessary. Over time, the patient returns to a full healthy life.

During the rehabilitation period, mental work is useful. It is important that the patient, especially if he had neurological disorders before the operation, takes care of himself as far as possible - this contributes to a faster and more complete rehabilitation.

The risk of possible complications

As with any operation, especially on the brain, a number of complications are possible with bypass surgery, so it is very important don't miss their first symptoms.

Symptoms of various complications:

Infection of the surgical wound makes itself felt:
- fever in the first days after surgery;
- headaches;
- nausea and vomiting;
- scar redness;
- disorders of gait, coordination of movements;
- fast fatigue.
Improper shunt placement leads to the fact that the symptoms of hydrocephalus after surgery do not go away, in addition, there are signs of inflammation - pain along the shunt, fever, edema. In order to prevent this, an MRI is performed after the operation.
A complication that usually occurs t a few years after the operation - clogging of the shunt. It is manifested by the return of symptoms of hydrocephalus - headaches, focal neurological symptoms, increased intracranial pressure.

In order to notice the first signs of shunt clogging in time, it is necessary annually visit a neurologist. If such a pathology occurs, the clogged shunt is removed and replaced with a new one.

Excessive accumulation of cerebrospinal fluid (cerebrospinal fluid, cerebral fluid) in the cavities (ventricles) of the brain leads to the development of hydrocephalus. This disease is dangerous with severe complications and requires immediate treatment. In some cases, doctors use brain bypass, which is considered quite effective for hydrocephalus. After the operation, the further life of a person completely depends on the work of the shunt. How is the procedure carried out, are there any contraindications, and what should the patient expect?

For over 50 years, shunting for hydrocephalus has been the standard treatment for any form of hydrocephalus. This is a rather complicated and risky procedure that allows you to restore blood circulation and the movement of cerebrospinal fluid, which significantly improves the patient's quality of life.

With hydrocephalus (dropsy of the brain), a large accumulation of cerebrospinal fluid in the ventricles causes an increase in intracranial pressure. As a result, the brain structures are compressed, which negatively affects its functionality. The cerebrospinal fluid protects the delicate tissues of the brain from mechanical and infectious damage, and provides metabolic reactions. If the balance between production and adsorption is disturbed, then the outflow of cerebral fluid worsens, because of which all metabolic processes in the brain and nervous system suffer.

Pathology is characterized by the following symptoms:

High intracranial pressure.
Painful attacks of cephalalgia.
body intoxication.
Coordination disorders.
Decreased vision, hearing, speech.

The patient's condition is rapidly deteriorating, so the doctor needs to prevent the situation from aggravating and create additional ways for the outflow of CSF. First, drug therapy is prescribed, but if it does not give results, and there is no improvement in the dynamics, then radical methods are used.

Brain shunting in hydrocephalus occurs with the diversion of cerebrospinal fluid in:

Pleural cavity.
Bladder.
Abdominal cavity.
Pericardial bag.

Shunts in the head are installed depending on the cause of the pathological condition:

Excessive production of cerebrospinal fluid.
Violation of the outflow of cerebrospinal fluid (partial or complete) due to atrophy of the brain tissue.
Narrowing of the outflow.

Hydrocephalus is a dangerous disease that affects newborns and adults. The reasons for its occurrence can be very different: congenital malformations, ischemia, trauma, cysts, tumors, the consequences of infectious diseases, birth trauma.

You need to know that after the procedure, only the symptoms of the disease will disappear. But it is impossible to cure the reason why the fluid from the ventricles of the brain does not depart with the help of shunting.

If the pathology is of a minor nature, then drug treatment is used. In all other cases, only one method is used - shunting. It allows:

Normalize the outflow of cerebrospinal fluid, which will save the brain from CSF pressure.
Restore brain function.
Get rid of neurological symptoms.
To prolong human life and reduce the percentage of early mortality (75% of newborns with hydrocephalus die in the first year of life if surgery is not performed in a timely manner).

In some cases, shunting of the vessels and arteries of the brain is performed. Such a procedure is shown for blockage of the arteries of the brain, which leads to impaired blood circulation. Neurons do not receive enough oxygen and nutrients, which is why they begin to die. Timely surgery helps to avoid a stroke - the cause of death of many people.

Shunting is required for:

Occlusion of the carotid arteries.
Aortic aneurysm.
Tumors of the brain.

The procedure is performed under general anesthesia. Before the operation, it is necessary to carry out certain examinations, allowing you to choose the most appropriate bypass methods:

Cardiogram.
Fluorography.
Blood and urine tests.
Magnetic resonance thermogram.
CT scan.
Ultrasound examination of the arteries.

As soon as the results of the diagnosis are known, the patient confirms his consent to the surgical intervention in writing. At the same time, the possible risks and complications are described to him. If brain bypass is to be performed on newborns, consent must be given by the parents.

Before the operation itself, the patient needs to take a shower and wash his hair. In some cases, the hair needs to be shaved. All foreign objects (earrings, glasses, piercings, dentures, contact lenses) are removed from the head. A few weeks before the scheduled operation, the patient is advised to avoid drinking alcohol, smoking, and taking non-steroidal anti-inflammatory drugs. Eight hours before the procedure, the patient does not eat anything (it is allowed to drink water in limited quantities).

Shunting of vessels and arteries of the brain allows you to create a new branch of blood flow that bypasses the problematic vessel. A vein or an artificially created blood vessel is used as a shunt. It is sewn behind the injury site or in front of it. After this operation, blood circulation resumes in a new area.

Shunting for hydrocephalus goes like this:

The patient is covered with sheets and the areas where the incisions will be made are left open.
Places of CSF shunting are lubricated with an antiseptic.
A burr hole is made through which a drainage tube (shunt) is brought to the brain.

Removal of the tube into the abdominal cavity is extremely rare, as it is associated with a high risk of complications. A ventriculoatrial shunt is considered safer, in which a drainage tube is inserted into the left or right atrium. In such cases, the shunt will be short, which means that the risk of complications is minimized.

The next step is to lay a shunt in the soft tissues, synchronizing the path of the drainage tube with the arteries. Next, the shunt is installed in the required ventricle through the burr hole. Modern doctors use drainage tubes equipped with special valves that prevent backflow of CSF, which provides additional reliability and functionality of the operation. Shunting in the same way is carried out in children.

Patients with heart failure and infectious diseases may be denied surgery. Immediately after the procedure, a person feels weakness, headache, dizziness. This is a normal condition that people experience in the postoperative period. During this period, patients undergo MRI to assess the state of the brain.

Recovery of the patient requires taking certain drugs (antibiotics, painkillers). If the pressure is elevated, diuretics are used in combination with Mannitol.

In addition, you need:

Refuse to work that requires increased concentration and quick reaction.
Avoid overwork and heavy physical exertion.

Shunting for hydrocephalus can lead to serious complications. 20% of patients already in the first year have to use a second intervention.

After surgery, you may:

Develop an infectious process. In most cases, this is due to the ingestion of staphylococcus aureus.
A subdural hematoma is formed, which in the future resolves without medical intervention.

In addition, the installed conducting system as a result of natural processes (for example, the growth of a child) may fail. In some cases, after a craniotomy, patients may experience:

Blockage of the shunt in any area.
development of epilepsy.
Consequences of damage to brain tissue during surgery.
Kinked or twisted shunt
Excessive or insufficient outflow of cerebrospinal fluid from the cerebral cavities.
Stroke, which is the result of a clamping of the arteries or the formation of a blood clot in a blood vessel.

With shunting of cerebral vessels, the following may occur:

Arrhythmia.
Coronary artery disease.
Heart attack.
Chronic pain in the area of operation.
Infection.
thrombosis of the arteries.

Despite the complexity and danger of this type of operation, the forecasts of specialists about the further condition of patients are quite favorable and optimistic. The shunt, being a kind of prosthesis that replaces the cerebrospinal fluid, helps to significantly improve the well-being of patients and avoid the development of serious consequences.

Shunting is common name operations related to the creation of additional pathways for the movement of biological fluids. They are carried out with the help of implants, which create opportunities for circulation. Brain shunting is divided into two types - the restoration of blood flow and the reduction of CSF volume. These are complex operations with a high risk of complications. But they give patients a chance for a normal full life and development.

Hydrocephalus is an excessive accumulation of fluid (cerebrospinal fluid) in the cavities of the brain. It can be external (subarachnoid space affected), internal (ventricular affected), or general/mixed (both affected). The ventricles are the internal cavities of the brain, the walls of which produce a special liquid - cerebrospinal fluid, which serves to nourish the deep layers of the brain. The subarachnoid space separates the layers of the medulla.

in hydrocephalus (right), excess CSF causes increased pressure in the cranium

According to the type of communication of the ventricles of the brain and the subarachnoid space, hydrocephalus is open (the message is preserved) and closed or occlusive (the message is broken). It is in the second case that shunting is necessary.

Surgery is especially important for congenital hydrocephalus, as it leads to a serious developmental delay that will be difficult to correct later. The decision to operate newborns should be made by parents, this option can only be recommended to them after the diagnosis is confirmed by CT or MRI. Sometimes you can get by with conservative therapy - when the process progresses slowly, the doctor informs the parents about the possibility of such treatment.

A cyst is an enlargement or cavity filled with fluid. The technique for its drainage is similar to the installation of shunts in hydrocephalus. The operation is used infrequently due to the high risk of infection. Sometimes the outflow of CSF by installing a shunt is necessary for brain tumors that are accompanied by hypertension - an increase in intracranial pressure.

The tumor can also, along with ischemia, trauma, and infection, cause hydrocephalus in adults. It is also treated promptly, by installing a shunt. This allows patients to return to work in almost 100% of cases or significantly improve their quality of life.

In modern neurosurgical practice, the following options for brain bypass in hydrocephalus are possible:

Formation of porencephaly. This type of intervention is a connection between the ventricle and the subarachnoid space. It is short-term due to the infection of the formed anastomosis.
Ventriculocisternotomy. The wall of the ventricle is perforated and a message is created between it and the basal cisterns (extensions of the subarachnoid space). In fact, the operation is very similar to the previous one, but allows you to achieve a longer effect. The message is restored using a thin PVC tube.
Establishment of cerebrospinal fluid shunts. In this variant, the location of the shunt is not limited to the brain, but affects the heart, abdominal cavity, bladder, etc. These are the operations most often performed, since they are characterized by a relatively prolonged effect. Such a shunt is characterized by the presence of a valve that opens only when the intracranial pressure reaches a certain predetermined parameter. This technique will be described in detail below.

example of a ventriculoperitoneal shunt

Technique

The operation is performed under general anesthesia. The patient is covered with sheets except for the incision sites. All areas subject to surgical intervention are treated with aseptic preparations. The surgeon seals the intended path of the shunt with a medical transparent film.

The catheter can be placed in the non-cerebral region (when using the abdominal cavity) or in the ventricles of the brain (when using the heart bag). After fixing it, the surgeon cuts the path of the shunt in the subcutaneous tissue. It is brought to the brain through a burr hole.

The risk of undesirable consequences after the operation is quite high. The need for re-intervention in the first year after bypass surgery occurs in 20% of cases. Almost half of the patients undergo numerous surgeries throughout their lives.

The most common complications are:

Mechanical dysfunction - that is, the termination of the effective operation of the shunt. It occurs both as a result of natural changes in the body (with the growth of the child who underwent surgery, lengthening of the artificial canal is also necessary), and as a result of adhesive, inflammatory, tumor processes or insufficient qualifications of the surgeon. The complication requires replacement of the shunt.
Infection. It can occur as an exacerbation of the inflammatory process of the brain or as a result of infection. In 90% of cases, the causative agent is the bacterium staphylococcus aureus. For prevention, it is necessary to take antibiotics for any inflammation, including caries. Conservative treatment is rarely successful, most often it is necessary to remove the shunt and, after getting rid of the infection, install a new one.
hydrodynamic dysfunction. Sometimes the shunt system does not provide normal pressure in the ventricles of the brain. This can only be corrected by replacing the valve. In rare cases, the ventricles pathologically change, subside, take the form of a gap. Even a small jump leads to nausea, vomiting, dizziness. Treatment appears to be unpromising.
subdural hematoma. This is a hemorrhage between the membranes of the brain. Most often it develops in elderly patients (over 60 years). Hematoma in most cases does not have any symptoms and resolves itself. With an unfavorable clinical picture, drainage is performed and the valve is replaced or reprogrammed to a higher pressure.

Indications

Candidates for surgery are the following categories of patients:

Persons with insufficient blood supply to the brain. This can be established during MRI, CT, angiography or duplex scanning against the background of characteristic symptoms (noise in the head, migraines, memory impairment, decreased performance).
Persons with lesions of the internal carotid artery. It can be an aneurysm, a tumor, atherosclerosis that does not respond to other therapies.
Persons with tumors at the base of the skull.
Patients with blockage or stenosis of the intracranial artery.

atherosclerosis, blockage of an artery in the brain - a typical indication for bypass surgery

Preparing for the operation

The attending physician informs the patient about all possible consequences and obtains his written consent to the operation. Before shunting, it will be necessary to pass standard tests (urine, blood, ECG, fluorography).

A week before surgery, you should stop taking any steroid drugs, smoking and alcohol, as they increase the risk of bleeding during vascular manipulation. In the morning before the procedure, you need to refrain from eating, all prescribed medicines must be washed down with a small amount of water.

On the eve of the bypass, it is important to take a hygienic shower and wash your hair twice. Before the operation, you need to remove all jewelry, false nails, eyelashes, removable dentures. The nurse shaves off the part of the head that will be trepanned. Sometimes they need to be completely removed. Before the operation, you need to calm down and tune in to a successful outcome.

The essence of this operation is to create a bypass for blood in case of blockage of the vessel. An impassable (occlusive) or narrowed (stenotic) artery is connected through an anastomosis jumper to a healthy one. As a result, new pathways for blood appear and brain nutrition is restored.

Depending on the normal blood flow velocity of the affected vessel, two types of operations are distinguished:

an example of creating a cerebral artery shunt from a vein

Sewing in a section of a large vein or artery. To exclude rejection after surgery, the patient's own vessels are used during bypass surgery. If a large artery is affected, the surgeon truncates for this purpose a fragment from the great saphenous vein of the leg or the radial / ulnar artery of the arm. The shunt is sewn into the affected vessel in two places - above and below the obstacle. Its other end is passed subcutaneously through a burr hole drilled in the skull and connected to the carotid artery in the neck.

Sewing in a portion of a vessel of small diameter. For these purposes, small arteries are used that supply the scalp - the scalp. They are also taken to the damaged vessel through the burr hole and connected to it. Thus, they begin to deliver blood to the brain instead of the scalp. If the length of a healthy vessel is not enough, inserts from excised fragments of other arteries or veins are possible.

Cerebral vascular shunting is performed under general anesthesia and lasts about 3 hours. After the action of the anesthetic, the patient's head is either fixed rigidly or freely placed on the opposite side to be operated on. This is followed by the isolation of the donor artery. The surgeon makes an incision along its course and removes the vessel completely or cuts out the necessary part, stitching the edges.

The next stage takes place directly in the brain. The surgeon drills out a section of the skull and temporarily removes it. After that, he opens and pushes the membranes of the brain to the location of the damaged vessels. Stitching of the artery with the donor vessel is performed under a microscope. They are additionally fixed with temporary clips. After checking blood flow using contact dopplerography. If there are no leaks, the clips are removed.

The surgeon sews up the hard shells of the brain, the bone flap is returned to its place. It is fixed with sutures, plates. When using a scalp vessel, the surgeon can reshape the flap with wire cutters to prevent compression. Next, the skin and muscles are sutured. The surface is treated with an antiseptic and sealed.

After the end of the anesthesia, the patient may be disturbed by dizziness, pain and sore throat. He needs to be prepared for the fact that the medical staff will constantly ask him to move his finger or foot, to name the objects shown. Important! This may cause some inconvenience, but it is necessary to control the patient's condition. Getting up is allowed on the second day. With satisfactory health and good tomography results, the patient is discharged on the 7th-8th day after the operation.

At home, in the first 2-4 weeks, you need to give up lifting weights, any work, including washing and mopping. Anticonvulsants and non-steroidal anti-inflammatory drugs may be prescribed medicines. After some operations, you will have to take antiplatelet agents (acetyl salicylic acid and others) all your life.

Until the surgeon assesses the patient's condition as stable, he should not return to work or drive a car. Alcohol should not be taken until the course of medication is completed. During the recovery period, walking with a gradual increase in distance and a slow pace is useful.

There are three most common complications after brain bypass surgery:

Stroke. It is a consequence of the incorrect work of the surgeon (clamping of the arteries) or the formation of a blood clot in the vessels.
Epilepsy. It is caused by a sudden flow of blood to certain areas of the brain. As a result, swelling and convulsions develop.
Shunt thrombosis.

Hydrocephalus can be treated free of charge, such assistance must be provided to the patient. Appeal to private clinics depends solely on his desire. The price can range from 15,000 to 150,000 rubles. When performing the procedure under the CHI policy, the patient can use a free shunt or purchase it on his own.

Shunting of cerebral vessels is carried out according to a quota, i.e., at first certain categories of citizens receive it after the conclusion of a medical commission. The price ranges from 15,000 to 70,000 rubles.

During vascular bypass surgery, patients, as a rule, assess their condition well and are grateful to doctors. It is extremely important to follow the recommendations of the doctor - this is the main guarantee of a stable condition.

After the surgical treatment of hydrocephalus, patients leave a wide variety of reviews, especially when it comes to a child. Many are faced with the demand for a bribe, the rude attitude of the staff for free treatment. This becomes a great trauma for patients and undermines their confidence in official medicine.

Shunting is a complex operation, fraught with a variety of consequences. But for some diseases only it gives patients a chance for a normal life.

Hydrocephalus is the process of accumulation of fluid in the brain. The cause of this phenomenon is the blockage of blood vessels, which disrupts the normal drainage of cerebrospinal fluid from the skull. Excess fluid can injure fragile brain tissue and lead to serious impairment in the functioning of the body and even death. Brain shunting is used in 90% of cases of treatment of such a pathology.

Hydrocephalus

The causes of this disease in children may be the following:

Prematurity. Early labor, stimulated external factors, provoke an increase in intracranial pressure in an still underdeveloped fetus. This process is the body's response to change. external environment and trying to adapt to it.
A brain tumor. This disease is rarely diagnosed in newborns. More often, disturbances in the structure of the brain and the process of tumor formation are recorded in infants from six months to one and a half years. It is during this period that the processes that began to develop even in the womb pass into the stage of tumor formation, which disrupts the outflow of fluid from the head.
Physical injury. The consequence of such an injury is a concussion and an increase in pressure inside the skull in premature and newborn babies, which leads to the development a large number cerebrospinal fluid.

The disorder occurs not only in young children, but also in middle-aged and older people. Gait problems, urinary incontinence, slow perception and thinking - such symptoms can be observed in older people with hydrocephalus.

Rationale for shunting

When diagnosing hydrocephalus at an early stage, a course of drug treatment is prescribed. This treatment aims to reduce pressure inside the skull and promote the natural drainage of fluid from the brain. However, if the disease progresses rapidly, such treatment does not make sense. In this case, it is possible to use endoscopic ventriculostomy. This procedure avoids the introduction of a foreign body into the brain, as occurs with bypass surgery, and reduces the number of risk factors. However, such an operation is possible only for patients with a closed form of hydrocephalus, which is about 10% of the total number of patients.

As a result, cerebrospinal fluid (spinal fluid) shunting is used in almost 90% of cases of "dropsy of the brain" and is the main method of treating this pathology. The operation is considered quite risky due to the possibility of pathogenic bacteria entering the brain along with the shunt system. The need for frequent replacement of the shunt during surgery leads to the possibility of reinfection. Various complications occur in almost 55% of cases, in 60% of cases, patients who have undergone cerebral vascular bypass surgery become dependent on this procedure and need it again after a certain time.

Operation

The bypass procedure takes approximately 1-1.5 hours. A hole is made in the patient's skull, into which a special device made of silicone and soft materials is inserted. A cavity is created under the skin for the catheter and valve, then a shunt is inserted into the cavity. The bottom line is to use a shunt system to remove fluid from the ventricles of the brain into another cavity of the body, most often into the abdominal cavity, where the cerebrospinal fluid is absorbed by the intestinal cavities. In other cases, fluid can be discharged either into the right atrium or into the spinal canal, which is connected by a catheter to the intestinal cavity.

The amount of fluid removed from the brain is regulated by a valve, which eliminates the possibility of a sharp drop in pressure with subsequent complications. A successful operation stops the accumulation of fluid and the progression of the disease. After the operation, the patient is under observation in the hospital for three days.

Effects

Cerebral bypass surgery has certain risks, such as:

internal bleeding;
violation of blood circulation in the brain;
arterial thrombosis;
myocardial infarction;
infection in the wound during the procedure;
arrhythmia;
chronic pain in the area of the surgical wound.

All of the above complications are affected by the patient's diseases associated with the work of the heart and circulatory system, vascular atherosclerosis, and immune diseases. Women, the elderly, patients with kidney failure and bleeding disorders are at higher risk. All this greatly increases the likelihood of complications both during surgery and in the postoperative period.

Elderly women have a higher risk of complications due to narrowing of the coronary arteries, which threatens with possible thrombosis of the inserted shunt after a certain time after the operation. This complicates the procedure and shortens the life of the implant. In this case, it is recommended to use a shunt system made of a more rigid material.

A serious complication is myocardial infarction caused by impaired blood circulation and arrhythmia, which has developed due to dysfunction of the left atrium. Such a violation significantly reduces the chances of a successful operation and subsequent recovery. Patients with a bleeding problem are at risk both during and after surgery. During the operation, the patient is connected to a heart-lung machine, and the problem of blood clotting can cause internal bleeding. In the postoperative period, if the shunt is damaged or misplaced, the walls of the conducting artery may be injured, which also threatens to bleed.

With a successful outcome, the main consequence of the operation is lifelong rehabilitation. The patient is prescribed a course of medications designed to reduce intracranial pressure and relieve swelling. Physical activity, alcohol consumption and smoking are contraindicated, it is prescribed special diet. It will be necessary to monitor the health of the bypass system and the safety of the donor artery, damage to which can lead to cerebral hemorrhage.

Cerebral vascular shunting is the most effective treatment for hydrocephalus and is used in most cases. The development of various postoperative complications is most often associated with the presence of concomitant diseases in patients, which not only complicate the bypass procedure, but also reduce the chances of a full rehabilitation.

Turbine oils. General requirements and properties

What is shunting for cerebral hydrocephalus

Indications for surgery

Kinds

Shunting methods

results

The mechanism of formation of hydrocephalus

Causes of hydrocephalus development

Symptoms of hydrocephalus

Shunting of the CSF system

CSF bypass technique

Possible complications after surgery

Reading strengthens neural connections:

Features of hydrocephalus

Symptoms

Brain shunt

Shunt and working principle

Preparation for the procedure

Features of rehabilitation

The rehabilitation process

The need to replace the shunt

Is the patient considered disabled?

Possible Complications

Conclusion

Brain bypass surgery in children, adults and newborns: consequences

Training

Operation

Effects

Technique

Indications

Preparing for the operation

Hydrocephalus

Rationale for shunting

Operation

Effects

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