Andi Ihwan, SpBS

Bagian Bedah Saraf FK Unhas

 Abnormal enlargement of the ventricels due to an
excessive accumultion of CSF resulting from a
disturbance of its flow, absorption or secretion.
 Prevalence : 1-1,5%
 Type:
 Patophysiology
 Communicating
 Noncommunicating
 Present
 Congenital : 0,9-1,8/1000 birth
 Acquired
Neonatus - Infancy
 Progresive head enlargement
 Cranium enlarges ata rate > facial growth
 Bulging fontanelle
 Enlargement of scalp veins (vena ectasis)
 Macewen’s sign: cracked pot sound
 Sunset phenomenom
 Splitting cranial sutures
 Transilumination
Children:
 headache, vomiting, diplopia, ataxia, visual loss,
behavioral changes
 Raise ICP, Cushing’s triad: bradycardia, hypertension,
decreased RR
 Symptom
 Imaging:
 USG
 Head CT Scan
 MRI
 Plain X-Ray
 Brain atropy
 Hydranencephaly
 Developmental anomaly: agenesis corpus
callosum
Goals:
 Relieve hydrocephaly

 Treat complications

 Manage problem resulting from effects of

disorder on psychomotor development
 USUALLY SURGICAL!
 Medical:
 Diuretics: Furosemida : 1 mg/kg/day TID
 Acetazolamide : 25 mg/kg/days TID
 Temporary: Eksternal ventricular drain
 Persistent : Shunt
 Endoscopic Third Ventriculostomy (ETV)
 Therapy of choice!
 Direct removal of source of obstruction
(neoplasm, cyst, or hematoma)
 Most require shunt procedure to drain CSF
from ventricles to extracranial area; usually
peritoneum(VP shunt), or right atrium (VA
shunt) for absorption.
Type:
 VP (ventriculoperitoneal)
shunt
 VA (ventriculoatrial)
shunt
 VPl (ventriculopleural)
shunt
 LP (Lumboperitoneal)
shunt
 Shunt infection is most serious complication!
 Period of greatest risk is 1 to 2 months
following placement.
 Staph and strep most common organisms
 Mechanical difficulties
kinking, plugging, migration of tubing.
 Malfunction is most often by mechanical
obstruction!
 Look for signs of increased ICP; fever,
inflammation and abdominal pain.
 Slit ventricel
 Subdural hematoma
 Underlying
disease
 Cerebral mantle
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