脑积水Hydrocephalus.pptVIP

Treatment of hydrocephalus The two most commonly used shunt systems are the ventriculoatrial (VA) and ventriculoperitoneal (VP) shunts. The VP shunt is most commonly used as it is simpler to place, extra tubing may be placed in the peritoneum and the consequences of infection are less. Treatment of hydrocephalus The VA shunt must be accurately located in the atrium and requires frequent revisions as the child grows to maintain the proper position of the distal end. In addition, infection is a more serious complication with a VA shunt as its location in the blood stream may lead to sepsis.  Treatment of hydrocephalus Recently, in situations where both the abdomen and vascular system can no longer function to absorb CSF, Pediatric Neurosurgeons have begun to place the distal catheter in the pleural space (V-PL shunt). The distal catheter is placed through a small incision in the anterior chest wall. As with the peritoneal shunt, extra tubing can be placed, reducing the need for further shunt revisions.   Treatment of hydrocephalus Shunt systems include three components: (1) a ventricular catheter, (2) a one way valve and (3) a distal catheter. The ventricular catheter is a straight piece of tubing, closed on the proximal end and usually with multiple holes for the entry of CSF along the proximal two centimeters of the tube.  Treatment of hydrocephalus Shunts are composed of a material called Silastic. Silastic is made from a family of polymerized organic compounds termed silicone. Silicone is the substance that has caused controversy in breast implants because of the association with auto immune disorders. So far no cases of auto immune disease have been linked to the Silastic used in shunts.  Treatment of hydrocephalus The most common sites for entry of the ventricular catheter are a frontal position in line with the pupil at the coronal suture, a parietal position just above and behind the ear, or an occipital position three centimeters off the posterior