Cerebrospinal fluid bypass surgery. Brain bypass surgery as a treatment for hydrocephalus

06.03.2020

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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, normal brain development in such conditions is impossible. The only way to treat 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 bypass surgery:

Ventriculo-atrial (connection of the ventricle with the right atrium, less often with the left);
Ventriculoperitoneal (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 solid meninges with a peritoneum);
Ventriculo-pleural;
Ventriculo-urethral (a rare type of bypass, connection of the ventricle with the urethra).

Which method will be used in each specific case depends on:

concomitant diseases;
general condition.

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

These tubes are further:

do not impede movement;
do not disturb 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 performed as early as possible. This is due to the fact that with congenital hydrocephalus, the development of the brain is impaired, which leads to abnormalities in the psyche and mental development 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 ventricle the violation occurred.

Bypass surgery normalizes the outflow of cerebrospinal fluid from the ventricles of the brain, thanks to this, intracranial pressure is also normalized, which allows you to get rid of headaches.

The overcrowded ventricle ceases to squeeze the adjacent structures of the brain, therefore, the neurological disorders caused by hydrocephalus disappear, and the lost motor functions are restored.

In newborns, due to the peculiarities of physiology, the 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 movement disorders in the child.

Timely bypass surgery allows you to stop this process. The child's brain is very plastic, and the functions of the damaged parts 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, the reverse development does not occur, but as the child grows, the proportions of his body may return to normal.

Before performing bypass surgery:

The patient will be assigned a series of tests. Disturbances in the structure of the ventricles, the accumulation of fluid in them and damage to the brain are primarily visible on MRI. This study allows you to get the most complete picture of violations of the outflow of cerebrospinal fluid 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 in conjunction with MRI or CT) to identify possible violations of blood flow in the brain, the risk of bleeding during surgery, peculiarities of the location of blood vessels.
Additionally, a study is carried out of the cavity into which it is planned to remove the cerebral fluid. If the atrium is chosen in this capacity, it is necessary to do an ECG, EchoCG, Doppler ultrasonography 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 are performed abdominal cavity to identify possible contraindications to the operation.

If the operation has already been scheduled, then the patient needs to:

Take a shower twice - in 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.
The hair on the head must be shaved (this is done by the nurse) in whole or in part.
You need to take off your glasses contact lenses, dentures, earrings and piercings - during surgery, there should be no foreign objects on the head.
All decorations, mobile phone and other valuables must be given to relatives in advance or handed over to the storage room.

The cost of the operation varies depending on the region and on the characteristics of the clinic, but we can definitely say 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 patient spends the first day of the postoperative period in neuroreanimation. This is necessary in order to ensure the most careful observation of the patient and in time to notice the deterioration of the condition, if it happens. If necessary, the period of stay in intensive care is extended.

If postoperative period proceeds without complications, then within 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 to prevent the development of infection.

Other medications are prescribed:

anticonvulsants;
pain relievers;

After the operation, the patient undergoes an MRI - the first time a day after the operation, if necessary, the analysis can be prescribed again. Make sure the shunt is in place, loosely positioned and performing its function.

After discharge from the hospital:

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

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

Symptoms of various complications:

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

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

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

The nervous system is 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 receives thanks to the cardiovascular system. 4 large arteries wash over the brain, and stenosis (narrowing of the vessel lumen) or occlusion (complete obstruction) causes significant dysfunction nervous system generally. 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: right and left carotid, right and left vertebrates. With stenosis of any of them, the patient has focal symptoms depending on the localization of the lesion.

Bypass grafting of cerebral vessels is a method 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 split second, many different processes take place in it, on which the vital activity of the whole organism depends.

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

IN modern medicine practice 2 types of bypass surgery: autodonor bypass and bypass from the scalp arteries. 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 individually for each patient.

In autodonor bypass grafting, a vessel is taken from a patient, usually from the radial or ulnar artery of the arm or part of a large saphenous vein legs. One end of the taken vessel is sutured to the external carotid artery, then it is carried out subcutaneously and through a previously prepared trepanation window it is sutured to the clogged vessel above the site of stenosis. This option is used for the main arteries with high blood flow velocity. For smaller vessels, through which blood circulates at a lower intensity, shunts from the vessels of the soft tissues of the head (scalp) are used. This method is less traumatic due to the smaller volume 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 surgery, the blood supply to the brain improves.

Brain bypass surgery for hydrocephalus has a number of features, since it does not redistribute blood in the vessels, but the cerebrospinal fluid.

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

Epidemiology of hydrocephalus. Regardless of the etiological factors, congenital hydrocephalus occurs in two out of 1000 newborns. 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 reasons occurrence ( 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 - dangerous disease... Regardless of the etiology, it has a high mortality and disability rate among newborns. At this stage in the development of medicine, shunting is the only effective method treatment of hydrocephalus, despite the high percentage of complications, among which are:

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

The peculiarities 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, the newborn grows very quickly, and over time, the shunt ceases to cope with its functions, in addition, with the growth of the child, the shunt may move, this threatens to damage the brain and its structures. Hydrocephalus requires dynamic treatment.

The main purpose of bypass surgery for hydrocephalus is to redistribute cerebrospinal fluid in the ventricular system of the brain.

The main types of bypass surgery for hydrocephalus:

Ventriculoperitoneal shunting.
Ventriculoatrial shunting.

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

In the postoperative period, a patient with hydrocephalus is prescribed pain relievers and anticonvulsants, which the doctor selects, and he also sets the dosage.

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

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

Surgical surgery with bypass grafting of cerebral vessels is prescribed by specialists in the following cases:

with atherosclerotic lesions or carotid artery tumors;
with aneurysms that cannot be cured by intravascular methods;
if artery 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 brain dropsy. 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, 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 with the vessels, restore the disturbed blood supply.

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Preparation for bypass surgery consists of several methods of examining 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 cerebral vessels, indicates the foci of inflammation, details the size of the cyst, malignant tumor.
Ultrasound 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 the blood stops in the artery under study.

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

Preparation for surgery for adult patients begins one month before its date. The patient is prohibited from drinking alcoholic beverages, smoking, it is recommended to refuse others bad habits... The same rule applies to a month rehabilitation period... A week before bypass surgery, a ban on taking NSAIDs is introduced. Also, all the necessary urine and blood tests are taken from adults and children, and a neurosurgeon and neuropathologist are examined. A prerequisite is the passage of fluorography, the removal of an electrocardiogram.

The operation to bypass the vessels and arteries of the brain is performed in various 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 some of the damaged vessels, which cannot be done without craniotomy. Only a neurosurgeon can perform the intervention. Before the operation begins, written consent is taken from the patient or his relatives by signing a contract.

For the treatment of hydrocephalus in newborns, ventriculoperitoneal shunting is used. CSF from the ventricles of the brain through catheters is discharged into the body cavity, absorbed between the intestinal loops. The flow rate is regulated by a valve. This method saves thousands of children's lives around the world every year.

It is difficult to predict the consequences of cerebral bypass grafting. In the presence of a large cyst or tumor during surgery, there is sometimes a blockage in the ventricles or cavity, infection of the meninges. Also, damage to the shunt itself occurs, the formation of pressure ulcers of the organs. In the postoperative period, when treating hydrocephalus and tumors, blood clots may appear.

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

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If the surgery is successful, the patient is doing well. You may have complaints of sore throat where the ventilator tube was inserted. For some time the patient may be disturbed by nausea, headache, lack of appetite. This is a normal condition. Before discharge, an MRI scan is performed, a duplex scan to assess the operation of the shunt.

Bypass surgery is an intervention by a surgeon that affects the brain and aims to restore normal blood flow. Operation on the vessels of the brain can be performed in the form of bypass grafting of the arteries, this procedure helps to restore the functioning of the blood supply.

The operation is dangerous and difficult, and can also entail negative consequences, however, there are diseases where patients are in dire need of bypass surgery, because it is this that will guarantee 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.

Bypass surgery is necessary if:

The tumors have damaged the carotid artery;
The patient suffers from aneurysms that cannot be cured with open methods;
With rapid development ischemic diseasethat doctors cannot stop with medication.

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

Preparation for bypass surgery: wash your hair before the upcoming operation; in some cases, the doctor may 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 from alcoholic beverages, smoking two weeks before bypass surgery.
Do not use anti-inflammatory drugs.
Analysis of blood, urine
Make fluorography
Written consent to bypass surgery

Operation

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. A catheter is installed and fixed. The doctor cuts the path of the shunt in the subcutaneous tissue and brings it to the brain through the opening. Bypass surgery 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 were transmitted at an early age and transmitted to the child from the mother during pregnancy. Newborn bypass surgery is used to eliminate hydrocephalus (dropsy) of the brain There is a high risk of complications.

Drive a car by yourself;
Drink strong drinks that contain alcohol, and also refrain from smoking;
Do not load the body in the form of tedious physical work;
It is necessary to stay in the fresh air every day;
Strictly follow all your doctor's orders.

Effects

If a patient has a large cyst, a 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's 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, normal brain development in such conditions is impossible. The only way to treat this pathology is surgical.

Bypass surgery - 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 bypass surgery:

Ventriculo-atrial (connection of the ventricle with the right atrium, less often with the left);
Ventriculoperitoneal (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 mater with the peritoneum);
Ventriculo-pleural;
Ventriculo-urethral (a rare type of bypass, the connection of the ventricle with the urethra).

Which method will be used in each specific 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 brain bypass surgery the patient is introduced a system of tubes and valves that ensure the normal outflow of cerebrospinal fluid.

These tubes are further:

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

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

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

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

In older children and adults, the cause of hydrocephalus can usually be 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 ventricle the violation occurred.

Bypass surgery normalizes outflow of cerebrospinal fluid from the ventricles of the brain, thanks to this, intracranial pressure is also normalized, which allows you to get rid of headaches.

The overcrowded ventricle ceases to squeeze the adjacent structures of the brain, therefore, the neurological disorders caused by hydrocephalus disappear, recover lost motor functions.

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

In the future it threatens mental retardation and severe movement disorders The child has.

Timely bypass surgery allows to stop this process. The child's brain is very plastic, and the functions of the damaged parts 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, the reverse development does not occur, but as the child grows, the proportions of his body can bounce back.

Before performing bypass surgery:

The patient will be assigned a series of tests... Disturbances in the structure of the ventricles, the accumulation of fluid in them and damage to the brain are primarily visible on MRI. This study allows you to get the most complete picture of violations of the outflow of cerebrospinal fluid in the ventricles, and based on its results, the question of the need for surgery is decided.
Other Research: Angiography brain (X-ray examination of blood vessels, can be performed in conjunction with MRI or CT) to identify possible violations of blood flow in the brain, the risk of bleeding during surgery, peculiarities of the location of blood vessels.
Additionally, research is being conducted the cavity into which it is planned to remove the cerebral fluid. If the atrium is chosen in this capacity, it is necessary to do an ECG, EchoCG, Doppler ultrasonography 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 is performed to identify possible contraindications to surgery.

If the operation has already been scheduled, then the patient needs to:

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

Operation price

The cost of the operation varies depending on the region and on the characteristics of the clinic, but we can definitely say 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 observation of the patient and in time to notice the deterioration of the condition, 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.

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 the development of infection.

Other medications are prescribed:

anticonvulsants;
pain relievers;
with increased 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 prescribed again. Make sure the shunt is in place, loosely positioned 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 no complications have arisen, then the probability of their occurrence in the future is rather low.
Any physical activity, even minor, during this period should be agreed with the doctor. Exceptions to this rule are walking.
Professional sports are excluded until 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 stress, quit smoking, completely stop drinking alcohol.
Caffeine won't be helpful either.
Housework, like any physical activity, must be strictly dosed, you must not lift heavy objects.

Such strict restrictions persist for a month or moreif 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, as far as possible serve himself - this contributes to a faster and more complete rehabilitation.

Risk of possible complications

As with any surgery, especially on the brain, a number of complications are possible during 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:
- an increase in temperature in the first days after surgery;
- headaches;
- nausea and vomiting;
- reddening of the scar;
- violations of gait, coordination of movements;
- rapid fatigue.
Incorrect shunt installation leads to the fact that the symptoms of hydrocephalus after surgery do not go away, 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.
Complication that usually occurst a few years after the operation - clogging of the shunt. It is manifested by the return of hydrocephalus symptoms - headaches, focal neurological symptoms, and increased intracranial pressure.

In order to notice the first signs of shunt clogging in time, it is necessary annually come to see 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 ailment is dangerous with serious complications and requires immediate treatment. In some cases, doctors use brain bypass surgery, which is considered to be quite effective for hydrocephalus. After the operation, the further life of a person completely depends on the operation of the shunt. How is the procedure carried out, are there any contraindications, and what should the patient expect?

For more than 50 years, hydrocephalus bypass surgery has been the standard treatment for any form of hydrocephalus. This is a rather complicated and risky procedure that allows to restore blood circulation and movement of the 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. Cerebrospinal fluid protects the delicate tissues of the brain from mechanical and infectious damage, and ensures metabolic reactions. If the balance between production and adsorption is disturbed, then the outflow of cerebral fluid worsens, due to which everyone suffers metabolic processes in the brain and nervous system.

Pathology is characterized by the following symptoms:

High intracranial pressure.
Painful attacks of cephalalgia.
Intoxication of the body.
Coordination disorders.
Deterioration of vision, hearing, speech.

The patient's condition is rapidly deteriorating, so the doctor needs to prevent an aggravation of the situation and create additional pathways for the outflow of cerebrospinal fluid. 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 bypass surgery for hydrocephalus occurs with the discharge of cerebrospinal fluid in:

Pleural cavity.
Bladder.
Abdominal cavity.
Pericheral 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 tract.

Hydrocephalus is the most dangerous ailment that affects newborn children and adults. The reasons for its occurrence can be very different: congenital malformations, ischemia, trauma, cysts, tumors, the consequences of infectious ailments, 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 leave with the help of bypass surgery.

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

Normalize the outflow of cerebrospinal fluid, which will relieve the brain from cerebrospinal fluid pressure.
Restore brain function.
Get rid of neurological symptoms.
Extend a person's life and reduce the percentage of early mortality (75% of newborns with hydrocephalus die in the first year of life, if the operation is not performed in a timely manner).

In some cases, bypass grafting of the vessels and arteries of the brain is performed. This procedure is shown in case of blockage of the arteries of the brain, which leads to impaired blood circulation. Neurons do not receive enough oxygen and nutrients, because of what begins their withering away. A timely operation allows you to avoid a stroke - the cause of the death of many people.

Bypass surgery is imperative for:

Carotid artery occlusion.
Aortic aneurysm.
Brain tumors.

The procedure is performed under general anesthesia. Before the operation, it is necessary to conduct certain examinations in order 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 diagnostic results are known, the patient confirms in writing his consent to the surgical intervention. At the same time, the possible risks and complications are described to him. If brain bypass surgery is to be performed in newborns, parents must give their consent.

Before the operation itself, the patient must take a shower and wash his hair. In some cases, shaving off your hair is required. All foreign objects (earrings, glasses, piercings, dentures, contact lenses) are removed from the head. A few weeks before the scheduled surgery, 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).

Bypass grafting of blood vessels and arteries of the brain allows you to create a new branch of the blood flow bypassing the problem 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.

Bypass surgery for hydrocephalus is as follows:

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

Retraction of the tube into the abdominal cavity is extremely rare, as it is associated with a high risk of complications. A ventriculoatrial bypass 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 in soft tissues shunt, synchronizing the path of the drainage tube with the arteries. Then the shunt is placed in the required ventricle through the burr hole. Modern doctors use drainage tubes equipped with special valves that prevent the backflow of cerebrospinal fluid, which provides additional reliability and functionality of the operation. Bypass surgery is performed in the same way in children.

Patients can be refused surgery in case of heart failure and infectious diseases. 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.

Recovering a patient requires taking certain medications (antibiotics, pain relievers). If the pressure is high, diuretics are used in combination with Mannitol.

In addition, you must:

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

Hydrocephalus bypass surgery can lead to serious complications. 20% of patients have to use reoperation in the first year.

After the operation can:

An infectious process will develop. In most cases, this is due to the ingestion of staphylococcus.
A subdural hematoma will form, which resolves in the future without medical intervention.

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

Shunt blockage anywhere.
The development of epilepsy.
The consequences of damage to brain tissue during surgery.
A kinked or curved shunt
Excessive or insufficient outflow of cerebrospinal fluid from the cerebral cavities.
A stroke that results from clamping of an artery or the formation of a blood clot in a blood vessel.

When bypass grafting cerebral vessels may occur:

Arrhythmia.
Coronary artery disease.
Heart attack.
Chronic pain in the area of \u200b\u200bthe operation.
Infection.
Arterial thrombosis.

Despite the complexity and danger of this type of operation, the forecasts of specialists about the future condition of patients are quite favorable and optimistic. A 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 severe consequences.

Bypass surgery is the general name for 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 bypass surgery is divided into two types - restoration of blood flow and reduction of cerebrospinal fluid volume. These are difficult 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 (the subarachnoid space is affected), internal (the ventricles are affected), or general / mixed (both are affected). The ventricles are the internal cavities of the brain, the walls of which produce a special fluid - the cerebrospinal fluid, which serves to nourish the deep layers of the brain. The subarachnoid space separates the layers of the medulla.

with hydrocephalus (right), excess cerebrospinal fluid causes increased pressure in the skull

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

It is especially important to carry out the operation as soon as possible for congenital hydrocephalus, since it leads to a serious developmental delay, which will be difficult to correct later. The decision to operate on newborn children should be made by parents, this option can be recommended to them only after confirming the diagnosis by CT or MRI. Sometimes conservative therapy can be dispensed with - when the process progresses slowly, the doctor informs the parents about the possibility of such treatment.

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

The tumor can also, along with ischemia, injury 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 surgery for hydrocephalus are possible:

Porencephaly formation. This type of intervention is a connection between the ventricle and the subarachnoid space. It is of a short-term nature due to the overgrowth of the formed anastomosis.
Ventriculocisternotomy. The ventricular wall is perforated and a communication 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 communication 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. It is these operations that are performed most often, 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. It is this technique that will be described in detail below.

example of ventriculoperitoneal shunting

Technique

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

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

The risk of unwanted consequences after surgery is quite high. The need for re-intervention in the first year after shunting 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 a child who underwent surgery, lengthening of an artificial canal is also necessary), and as a result of adhesions, inflammatory, tumor processes or insufficient qualifications of the surgeon. Complication requires replacement of the shunt.
Infection. It can occur as an exacerbation inflammatory process brain or as a result of infection. In 90% of cases, the causative agent is the staphylococcus bacteria. 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 change pathologically, subside, take the form of a gap. Even a small jump leads to nausea, vomiting, dizziness. Treatment turns out to be of little promise.
Subdural hematoma. This is a hemorrhage between the lining of the brain. Most often develops in elderly patients (over 60 years old). The hematoma in most cases does not have any symptoms and resolves itself. With an unfavorable clinical picture drain and replace or reprogram the valve to a higher pressure.

Indications

The following categories of patients are candidates for surgery:

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

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

Preparing for surgery

The attending physician informs the patient about all possible consequences and obtains his written consent to carry out the operation. Before bypass surgery, you will need to pass standard analyzes (urine, blood, ECG, fluorography).

A week before the operation, you need to stop taking any steroid drugs, smoking and alcohol, as they increase the risk of bleeding when manipulating blood vessels. In the morning before the procedure, you must refrain from eating, all prescribed medicines must be taken with a small amount of water.

On the eve of bypass surgery, it is important to take a hygienic shower and wash your hair twice. Before the operation, you must remove all jewelry, false nails, eyelashes, removable dentures. The nurse shaves the hair off the part of the head to be trepanned. Sometimes their complete removal is required. 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 path for blood when a vessel is blocked. An impassable (occlusive) or narrowed (stenotic) artery is connected through an anastomotic bridge with a healthy one. As a result, new pathways for blood appear and the nutrition of the brain is restored.

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

example of creating a cerebral artery bypass from a vein

Sewing a section of a large vein or artery. To exclude rejection after bypass surgery, the patient's own vessels are used. 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 trepanation hole drilled in the skull and connected to the carotid artery on the neck.

Sewing in a small diameter vessel section. For these purposes, small arteries are used that supply the scalp - the scalp. They are diverted to the damaged vessel also through the trepanation opening and are connected to it. Thus, they begin to deliver blood to the brain instead of the scalp. If the length of a healthy vessel is insufficient, insertions from cut fragments of other arteries or veins are possible.

Bypass grafting of cerebral vessels 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. This is followed by the selection of the donor artery. The surgeon makes an incision along its course and removes the vessel completely or excises the necessary part, suturing 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. The artery is sutured with the donor vessel under a microscope. They are additionally fixed with temporary clips. After checking the blood flow using contact Doppler ultrasonography. If there are no leaks, the clips are removed.

The surgeon sutures the hard shells of the brain, returns the bone flap to its place. It is fixed with seams, plates. When using a scalp vessel, the surgeon can reshape the flap with nippers to prevent compression. Next, the skin and muscles are sutured. The surface is treated with an antiseptic and glued.

After the end of the anesthesia, the patient may experience dizziness, pain and sore throat. He needs to be prepared for the fact that the medical staff will constantly ask him to move a finger or foot, name the items shown. Important! This can cause some inconvenience, but it is necessary to monitor the patient's condition. It is allowed to get up on the second day. If you feel well and good results tomography is performed 7-8 days after the operation.

At home, in the first 2-4 weeks, you need to stop lifting weights, any work, including washing and mopping. Perhaps the appointment of anticonvulsant and non-steroidal anti-inflammatory medicines... After some operations, you will have to take antiplatelet agents (acetyl salicylic acid other).

Until the surgeon assesses the patient's condition as stable, he must 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 beneficial.

There are three most common complications after brain bypass surgery:

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

Hydrocephalus can be treated free of charge, and the patient is obliged to provide such assistance. Contacting private clinics depends solely on his wishes. The price can range from 15,000 to 150,000 rubles. When performing the procedure under the compulsory medical insurance policy, the patient can use a free shunt or purchase it independently.

Bypass grafting of cerebral vessels is carried out according to a quota, that is, at first it is received by certain categories of citizens after the conclusion of a medical commission. The price ranges from 15,000 to 70,000 rubles.

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

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

Bypass surgery is a complex operation, fraught with various consequences. But with a number of diseases only it gives patients a chance for a normal life.

Surgical treatment of pathologies such complex system the body, like the brain, is usually associated with high risk and high difficulty of performance. 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 developmental disorders and newborn children become its victims. Brain bypass surgery 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 excessive accumulation of cerebrospinal fluid in the skull. Cerebrospinal fluid (CSF) is the result of the secretory activity of the glands in the brain, and serves as a kind of nutrient solution and water cushion that protects the brain and spinal cord. In a normal state, the cerebrospinal fluid, produced in a volume of about 450 - 600 ml per day, is redistributed between the cranium and the 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 the hydrodynamic balance. Physiological disorders that impede the normal circulation of cerebrospinal fluid lead to the formation of hydrocephalus.

Reasons for the development of hydrocephalus

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

rubella;
cytomegalovirus infection;
syphilis;
toxoplasmosis.

Acquired hydrocephalus often results from:

inflammatory process in the tissues of the soft membrane of the brain (meningitis), which is responsible for the timely removal of cerebrospinal fluid;
suffered head injuries;
intracranial hematomas;
development of neoplasms that have deformed the pathways of circulation of the cerebrospinal fluid system.

Hydrocephalus symptoms

The symptoms of the development of hydrocephalus differ in different age categories... So, for example, the symptoms of dropsy of the brain in a newborn child are:

disproportionately large head;
intensive growth of the skull volume;
large and prominent fontanelle without signs of pulsation;
shift eyeballs downward or in the form of converging or diverging strabismus.

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

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

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

CSF shunting

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

Shunting is an artificial creation of fluid outflow paths by installing a system of thin polymer hoses. Depending on where the cerebrospinal fluid will be removed, the following types of shunting are distinguished:

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

The technique for placing shunts also depends on the reasons that caused an imbalance in the work of the cerebrospinal fluid system:

lack of regulation of cerebrospinal fluid production (overproduction);
violation 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 pathways of the outflow of cerebrospinal fluid.

In some cases, to normalize blood circulation, bypass grafting of the cerebral vessels is required.

You should know: despite the effectiveness of the use of shunting operations, they eliminate only the symptoms and manifestations of the disease, and are not able to restore the existing violations.

CSF bypass technique

Surgery to install the CSF bypass system is performed under general anesthesia. Depending on the type of bypass, the final piece of the drainage tube is placed in the abdominal, pleural or atrium. Typically, the atrial area is preferred because a shorter catheter is used, 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 cerebral shunt is placed 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

Carrying out operations to bypass the cerebrospinal fluid system in children, in 50% of cases, is accompanied by complications arising from the changes occurring 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 child's growth and development are completely dependent on his work.

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

The most likely complications after CSF bypass surgery:

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

You should know: all modern shunt systems are equipped with valves designed to maintain normal intracranial pressure and prevent fluid outflow in the opposite direction.

Despite the complexity of the operation, further forecasts are usually quite optimistic. The shunt system, being, in fact, a prosthesis that replaces the natural cerebrospinal fluid 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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Hydrocephalus of the brain occurs not only in a child, but also in an adult. With this disease, cerebrospinal fluid accumulates in the skull. Such a disease poses a threat to human health, and there can be serious complications.

Most often, brain bypass surgery for hydrocephalus is done for the elderly or children. Dropsy in a child, as a rule, is congenital, while the skull is large. In an adult, it may appear if other diseases have been transferred. It is difficult to detect this pathology, so there is a high risk of death. The outcome depends on at what stage the disease was found, and how hydrocephalus is treated.

There are several types of hydrocephalus, each of which has its own symptoms. Pathology is associated with a violation of the outflow of cerebrospinal fluid from the brain. There are such types:

Mixed... This type is considered the most serious disease. The volume of fluid increases outside the brain and inside.
Outer... There is an accumulation of fluid in the subarachnoid formations.
. Excess fluid accumulates in the ventricles of the brain.

The method of treatment will depend on the specific type, therefore it is important to determine the type of pathology when diagnosing. The disease is also divided into chronic and acute forms. In the first case, the symptoms are not bright, the ailment may continue long time... When acute form there is a rapid development of pathology, signs cannot be ignored, because they are strongly manifested. Symptoms:

Headaches can radiate to the eye area, often after the person has woken up.
Nausea can appear in the morning along with headaches.
Vomiting does not appear due to food intake. After a person vomits, it becomes easier for him.
Vision is impaired, there is a burning sensation in the eyes.
Drowsiness occurs due to the large volume of fluid in the brain.
Epilepsy occurs.

The most important thing is to understand in time that a person has cerebral hydrocephalus, and quickly begin treatment. You need to contact medical institution for the help of a doctor.

When hydrocephalus is diagnosed, it all depends on what form of the disease. If the disease is found only on initial stage development, this increases the chance that a person himself will be able to navigate in everyday life, society, and the disease will not affect his performance. It is necessary to immediately consult a doctor, if the first symptoms of the disease become noticeable, it is necessary to undergo more examinations. According to the doctor's prescription, she will undergo therapy and rehabilitation courses.

Hydrocephalus can threaten with not very good news from doctors in the last stage of the disease. One of the consequences is irreversible processes in the tissues of the brain, this is due to the fact that the cerebrospinal fluid presses on the brain.

The launched stage has the following consequences:

Reduced muscle performance;
Hearing and vision begin to disappear;
Breathing and cardiac system is impaired;
Mental impairment appears, thinking, memory decreases and attentiveness worsens;
Seizures of epilepsy are observed;
Dementia occurs;
Coordination is impaired.

With such complications, the patient is assigned a disability, the group is determined by the person's condition. If the disease worsens, and the brain has lost its capacity, then there is a high probability that the patient will fall into a coma or die.

Treatment

For a long time, bypass surgery has been performed for hydrocephalus. This is a rather complicated operation that allows to restore blood flow and movement of the cerebrospinal fluid. With dropsy of the brain, fluid accumulates in the ventricles and this leads to high intracranial pressure. This happens because there is pressure in the head and affects the performance of the brain. The patient's condition can quickly worsen, for this the doctor must take timely measures.

To begin with, appoint medications, but if no results are seen, then the patient is operated on. Shunting the brain with hydrocephalus is necessary to drain fluid into the bladder, abdominal and pleural cavities, pericardial sac.

Shunts for hydrocephalus are installed when a pathological condition occurs: a large amount of cerebrospinal fluid; in violation of the outflow of cerebrospinal fluid due to brain atrophy; narrowing of the outflow pathways.

As soon as all the above procedures are completed, the patient signs that he is not against the surgical intervention. The patient is told about the risks and complications of the operation, if bypass surgery for hydrocephalus is required in newborns, then the parents give permission. Before the operation, it is forbidden to take alcohol, smoke and drink non-steroidal anti-inflammatory drugs for a couple of weeks. No food is allowed 8 hours before surgery, and water can only be drunk in limited quantities.

The operation is performed as follows: a hole is made through which a shunt is inserted to the brain. The next step is to make the insertion into the soft tissue by a shunt, simultaneously making the path of the drainage tube with the arteries.

Next, a shunt is installed in the desired ventricle through the hole made. The operation consists in removing fluid from the ventricles of the brain into another cavity, for example, into the abdominal or right atrium. The amount of fluid that must leave the brain is regulated by a special valve, this does not allow the pressure to drop sharply.

Complications after surgery

When the operation takes place, the doctor makes a hole in the patient's head. There is a risk that infection and vascular damage can occur. After such a procedure, complications such as:

epilepsy develops;
the shunt can be avoided or bent;
blocking the shunt in different places;
tissue damage in the brain during surgery;
lack or excess of cerebrospinal fluid outflow from the head;
stroke.

Most of all complications can be obtained by women, the elderly, patients with renal failure and poor blood clotting.

This increases the likelihood of facing the consequences, both during and after surgery. The most serious complications can be heart attacks. Patients who have problems with blood clotting are connected to a heart-lung machine during surgery.

If the procedure is successful, the consequence may still be lifelong rehabilitation. The patient is prescribed medication, they will help reduce intracranial pressure and can relieve swelling. Physical activity, smoking and alcohol consumption are prohibited. A person needs to be on a diet.

Rehabilitation

After the anesthesia wears off, the patient may have dizziness, sore throat, and pain. You can get out of bed only on the second day after the operation. If there is good health and positive dynamics on the tomography, the patient is discharged for 7-8 days.

It is forbidden to clean, cook and lift weights at home in the first 2-4 weeks. Medicines such as anticonvulsants and non-steroidal anti-inflammatory drugs are prescribed by your doctor.

Until the surgeon says that the patient is in a stable condition, you can not drive a car and visit work. Also, do not drink alcoholic beverages, it is better to give them up for life. During the rehabilitation period, you need to walk more, gradually you should increase your pace.

You need to know that bypass surgery does not cure the disease, but does not allow its consequences. To avoid recurrence of the disease, it is necessary to listen to what the doctor advises. It is important to lead healthy image life, eliminate bad habits, it will be useful to ride a bike and walk at a fast pace.

Brain bypass surgery is a complex surgical procedure and is performed by a neurosurgeon in specialized branches... The procedure requires replacing the damaged part of the circulatory system of the brain, if blood does not flow through it for any reason. Bypass surgery is also possible for the treatment of hydrocephalus, which is especially important for newborns, as well as people with traumatic injuries or other brain pathologies.

If a person has serious problems with cerebral blood vessels, then he needs to resort to bypass surgery. The recommendation for surgery is given by a specialist on the basis of a thorough full-scale screening, which confirms the impossibility of conservative treatment.

The procedure for installing a shunt system in people with cerebral circulation problems is recommended:

with a tumor in the brain;
if the carotid artery is affected by atherosclerosis;
in the absence of results from treatment with conservative methods;
in case of stenosis (narrowing) of the cerebral vessel;
to prevent transient attacks, if it is impossible to do it in other ways.

Bypass surgery is possible even in newborns in the first days of lifeif the child's health condition threatens his life.

Features of the procedure

Vascular bypass surgery can be performed using different methods - the choice of technique depends on the amount of damage to the vessel, as well as the underlying pathology, which provoked nutritional problems in the brain. Two types of interventions are common.

In the first type, a fragment of a vessel - venous or arterial - a shunt is used, which is removed from the patient. A donor site from the blood vessels of the extremities can be taken as such a shunt. This shunt is attached to the vessel on either side of the problem area, thereby allowing another pathway to direct blood flow in the desired direction.

The free end of the catheter is attached to the carotid artery, after which it is placed in the temple area, behind the ear. Then a part of the bone tissue of the skull is removed, a hole is made through which the catheter is attached to the cerebral vessel. The technique perfectly ensures the restoration of blood circulation in case of damage to a large-volume vessel with an active blood flow.

The second variant of the brain bypass procedure is the use of a donor vessel... Usually it is a small-diameter vessel located in soft tissues. Dedicated end blood vessel is brought through the hole to the pathological artery, after which it is fastened to it. The technique is used to treat blockage of small arteries in the head with low blood flow.

Recovery and rehabilitation

On the second day after the operation, patients undergo an MRI of the brain. The doctor looks for hemorrhages or areas of ischemia. A duplex scan is then performed to determine if the volume of blood flow is sufficient after head bypass surgery.

Brain surgery is always extremely difficult and responsible for the doctor... At the stage of rehabilitation, it is recommended to strictly adhere to the rules that the doctor will tell you. This will make it possible to return to normal life as soon as possible. During the recovery process you need:

follow all the doctor's recommendations for drug treatment;
do not drive a car until the doctor's permission;
do not drink alcohol, so as not to provoke puffiness;
do not play sports;
do not carry weights over 2-3 kg;
be in the fresh air daily.

Bypass grafting of cerebral vessels is a complex operation. The patient is at risk of bleeding, thrombosis, infection, inadequate body responses to anesthesia. It is always necessary to remember about the risk of developing epilepsy, stroke, closure of the shunt with a thrombus.

Hydrocephalus (dropsy) in patients childhood and adults are characterized by excessive accumulation of cerebrospinal fluid (fluid). The problem can be an independent pathology, such as congenital hydrocephalus.

Adults suffer from it due to various diseases. The disease requires mandatory correction in the neurosurgical department, since it can lead to disability and even death.

Indications

Brain bypass surgery is done to patients regardless of age. Usually dropsy with the need for surgical intervention is diagnosed in young children, as well as adults over 60 years old, when the body itself cannot cope with an excess of cerebrospinal fluid.

The reasons for the appearance of dropsy in the cerebral zone:

excessive production of cerebrospinal fluid;
problems with resorption (absorption) of cerebral fluid by cerebral vessels;
defects in the transportation of cerebrospinal fluid in the tissues of the medulla.

Dropsy usually occurs due to problems with fluid movement. Such a deviation of the cyst, inflammatory pathologies, brain tumors of a benign or malignant nature are provoked.

The shunt is a hollow tube, through which the excess of cerebrospinal fluid is redirected to the place of the body where there is the possibility of adequate absorption of fluid. For dropsy, several types of tubes are used with different characteristics, the installation of such structures makes it possible to prevent the severe consequences of hydrocephalus.

The bypass system has several components. The internal elements are represented by a silicone catheter. It is he who is introduced into the ventricle in the medulla, where cerebrospinal fluid accumulates in excess. The other end of the catheter is inserted into the storage tank.

The system also has a valve for regulating the discharged liquid. The liquor is directed through the outer part into the chest or abdominal cavity. The external section is the part of the shunt system that connects the internal catheter to the chest or abdominal cavity. This part of the shunt is performed subcutaneously by neurosurgeons and is not visible externally.

For dropsy, you can use the following shunts:

ventriculoatrial - the cerebrospinal fluid enters the atrium;
ventriculoperitoneal - drainage occurs into the abdominal cavity.

If these drainage techniques are not possible for any reason, the cerebrospinal fluid is withdrawn into the gallbladder or bladder.

An extremely important structural element is the valve. It allows the liquor fluid to flow in the right direction. The valve can regulate the volume of fluid entering the reservoir.

Features of the operation

The purpose of head bypass surgery for dropsy is to establish the outflow of fluid from the cavities of the brain, where it accumulates.

In the ventriculoperitoneal variant of the operation, the surgeon makes a hole in the skull and connects the end of the catheter to the cavity where the fluid is. The catheter is then positioned under the skin and reaches the abdominal cavity. Here the cerebrospinal fluid is actively absorbed

With the ventriculoatrial variant, the catheter is much shorter, which means the likelihood of complications is much less. For the shunts to work efficiently in the standing position, they are equipped with filters to restrain liquid backfill.

The effectiveness of the constructions is obvious, however, problems in patients appear already six months after the operation. In general, the patient suffers several surgical interventions throughout life. Such patients are called shunt-dependent.

Postoperative rehabilitation and prognosis

The therapy is evaluated the next day. The patient undergoes an MRI scan, and repeated examinations are performed seven days later, and immediately after the patient is discharged.

Rehabilitation of a patient after a brain bypass surgery has been performed includes receiving medications, rejection of bad habits, adherence to sleep and rest.

The patient uses the shunt system for life. Despite all the shortcomings of the operation, it is still widely used for dropsy. The quality of life of patients after the treatment is significantly improved.

Doctors check the shunt from time to time and replace it as needed. The procedure is necessary due to the growth of a small patient or a malfunction of the structure - wear, clogging. Modern systems are designed for a certain time, when the tubes require replacement - you cannot predict.

In case of blockage of the system and a violation of the drainage of the cerebrospinal fluid, patients are provided with urgent surgical care - the drainage is replaced with a new one.

The procedure for installing a shunt in the brain is a vital intervention, since cerebral pathologies can not always be cured conservatively. When installing a shunt, it is highly likely to relieve the severity of the pathology, but the catheters must be carefully monitored. Such patients are forced to constantly visit the clinic for revision of the shunt system. It is advisable for patients after surgery to give up bad habits, eat right, and protect themselves from stress.

Bypass grafting 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 the corresponding 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 impossibility of moving the fluid to the place of absorption. If non-occlusive - in failures during adsorption.

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

Various stenoses, craniovertebral anomalies, intrauterine infections, birth injuries, craniocerebral injuries, inflammation, vascular disorders, tumors, cysts, atherosclerosis, hypertension, diabetes can become the causes of problems with the ventricles and CSF metabolism.

In the absence of proper treatment, such a deviation is fatal.

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, then 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 finally ossify. You can identify the disease in infants by the following signs:

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

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

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

Brain bypass surgery

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

Bypass surgery is also performed upon detection of a tumor, atherosclerotic lesions, 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 the excess amount of cerebrospinal fluid will be discharged into the selected body cavity for future absorption in a natural way. There are three types of bypass surgery:

Ventriculoperitoneal is the most popular type that sends liquor into the abdominal cavity;
Ventriculopleural - a type in which fluid is drained into chest sick;
Ventriculoatrial - a rarely used type of bypass, when the cerebrospinal fluid 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. She is a kind of catheter. It is placed 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 to be passed to eliminate possible risks. Passing through the valve, the surplus enters the second part of the system - the reservoir. In it, the cerebrospinal fluid lingers for a while, after which it is sent to the outer section of the shunt, through which the liquid is poured into the selected cavity. A section of this part of the system is installed under the skin, which makes it invisible to prying eyes.

The valve that regulates the volumes of cerebrospinal fluid is fixed and programmable. In the first case, there are three modes of fluid transmission, each of which has a different intensity of work. The programmable one allows you to adjust the level of the valve's throughput when necessary. As a rule, when bypass surgery is performed for hydrocephalus in young children, they are first given a fixed valve, and only then replaced with a programmable one. Adults are immediately given the second type.

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

Preparation for the procedure

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

The attending physician can prescribe several examinations at once, each of which must be passed 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 narrowings;
Ultrasound scanning - provides accurate data on the state of all vessels in the body, including the cranial;
The study of occlusions using a balloon - this is how the body's response 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 the future procedure. If this is not done, there is a risk of serious complications that will extremely negatively affect 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 medications that have anti-inflammatory effects.

These two points are absolutely required in all cases. Additional preparation measures may be prescribed at the discretion of the physician. And before the operation, the patient's hair will be shaved off at 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. It is often accompanied by mild nausea, dizziness, headache of varying intensity, and slight numbness in the extremities. All these sensations can be expressed with different strengths. This is the norm.

On the second day after surgery, the doctor should assess the success of the bypass. To do this, the patient needs to undergo an MRI scan, which will help check the condition of the brain and exclude the likelihood of complications after the intervention. If everything is in order, then repeated examinations are carried out in another week and immediately upon discharge from the hospital. The total recovery time in the hospital is 14 days.

It will be normal for a person to look after the shunt is installed. all its components are almost invisible.

Rehabilitation process

After being discharged 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, since many factors can have a negative impact on the future state of a person and cause complications.

The convalescent is required to follow simple rules:

Complete rejection of alcohol and cigarettes before full recovery organism.
Any exception physical activity... A complete ban on lifting weights and all kinds of house or summer work.
Refusal to drive a car and all types of work that require concentration. There is a risk of an 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 \u200b\u200bthe postoperative opening. Any contact with this area can cause injury and rapid infection. Also, do not try to remove the shunt yourself.
Taking all prescribed medications as directed by your doctor. The patient is prescribed anticonvulsants. In this case, it is important to monitor your well-being, because they have a number of side effects.

Throughout the entire rehabilitation period, it is very important to strictly follow the instructions of your attending physician. This is the only way to avoid problems in the future and return to your usual life as quickly as possible. The patient will live a full life for a very long time with practically no restrictions. The life expectancy of those who had to be shunted practically does not differ from the average 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 the presence of a shunt remains forever. Therefore, a shunt addict should take his problem as seriously as possible. It is not as convenient as most patients would like, but the result with the ability to live peacefully is much more important.

The shunt needs to be changed from time to time. It gradually 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, they often have to be changed much earlier, regardless of the quality. Especially when it comes to children. Along with their gradual growth, lengthening and shunt will be required. The replacement is very quick and painless.

If the first need to check the equipment or replace it, you should immediately contact your doctor, because specialist 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 can expect to be awarded a degree of disability. This is determined by the commission, which makes a decision based on the research carried out. Both a child and an adult can be recognized as disabled if they have violations of the main categories of life, which include the following abilities:

self-service;
orientation in space;
movement;
training;
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, the patient is made a small hole in the head, which increases the risk of developing various complications in the future. It is very important to monitor your condition and regularly visit a doctor, and if you notice a deterioration in health, immediately call an ambulance.

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

introduction of 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 drainage;
no effect after shunting.

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

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

If the patient feels a significant deterioration in health, then it is imperative 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 a skin one) from taking medications prescribed by a doctor;
change in gait, weakness in the limbs or drowsiness;
the body temperature has risen to 38 ° C;
consciousness became confused, there was a constant headache with nausea.

In extreme cases, when the state of health has become very bad or bearable, but it is impossible to come to the doctor on this day, an ambulance should be called.

Conclusion

Brain bypass surgery for a disease such as hydrocephalus is a necessary procedure that enables 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.

Cerebrospinal fluid bypass surgery. Brain bypass surgery as a treatment for hydrocephalus

Brain bypass surgery in children, adults and newborns: consequences

Training

Operation

Effects

Technique

Indications

Preparing for surgery

The mechanism of formation of hydrocephalus

Reasons for the development of hydrocephalus

Hydrocephalus symptoms

CSF shunting

CSF bypass technique

Possible complications after surgery

Reading strengthens neural connections:

Treatment

Complications after surgery

Rehabilitation

Features of the procedure

Recovery and rehabilitation

Indications

Features of the operation

Postoperative rehabilitation and prognosis

Features of hydrocephalus

Symptoms

Brain bypass surgery

Shunt and working principle

Preparation for the procedure

Features of rehabilitation

Rehabilitation process

The need to replace the shunt

Is the patient considered disabled

Possible complications

Conclusion

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