Endoscopic and derivative procedures in hydrocephalus Treatment of hydrocephalus •observation •conservative treatment •surgery –temporary (acute HCP) •external ventricular drainage •external lumbar drainage –permanent (chronic HCP) •shunt •neuroendoscopy •others (Torkildsen drainage etc.) – • • Case 1 •female, 67-year-old •sudden onset – confused, impairment of speach •duration of symptomps: 10-15 min. •no other symptomps •physical exam negative Case 1 • • Case 1 •TIA •congenital hydrocephalus •no symptomps = no treatment Case 2 •male, 60-year-old •sudden onset of headache, vomiting •meningeal signs, no focal neurological deficit • • Case 2 • Case 2 • Case 2 • Case 2 • Case 2 • exacta silverline_final_01_s Medtronic bactiseal2 evd_ventricular_catheter1_l Case 3 •male, 40-year-old •sudden onset – headache, nausea, vomiting •CT exam – hydrocephalus •ophtalmoscopy – the edges of the optic disc unclearly defined •psychomotor slowing, dystaxia, no meningeal signs Case 3 • export--15513952 export--15513954 export--15513958 export--15513946 Case 3 •external ventricular drainage •MRI export--15573139 export--15573180 Case 3 •3rd ventriculostomy nf520939_fig1 clip_image012 Case 3 • export--18354681 export--15573138 Before OP After OP Case 3 • export--18519681 export--18354768 Case 3 • export--18520058 Case 3 • Case 4 •male, 48-year-old, SAH • Case 4 • • 1 month after SAH 5 months after SAH Case 4 •5 months after SAH •headache, memory disorder • 4 days after surgery Case 4 •VP shunt • • vp_shunt_3_areas_large proGAVFoto_transp vp_shunt_belly_large Case 5 •female, 55-year-old, SAH, aneurysm BA, coiling •hydrocephalus •implantation of a VP shunt •shunt malfunction – peritoneal cathetr •revision – laparoscopy – multiple adhesions • Case 5 • • Video_0123871 Image_022034 Case 5 •lesser trauma to the abdominal wall and peritoneum •possibility of performing adhesiolysis and exquisite visualization of the peritoneal cavity, with in situ testing of catheter function •lower risk of intraabdominal adhesions than laparotomy •diagnosis of abdominal pain •revision surgery •primary placement Trocar Case 5 •Laparoscopy is safe even without VP catheter clamping and with only routine anesthetic monitoring (Al-Mufarrej et al, 2005). •Risk of retrograde failfure minimal even with intraabdominal pressure as high as 80 mm Hg (Al-Mufarrej et al, 2005). Pneumoperitoneum Case 5 Laparo_scheme Uvnitr Placement of trocars X-ray after laparoscopic placement The end of the peritoneal catether Case 5 •VA shunt VA_Shunt_Final VA_Shunt_LatFinal heart_Final Case 6 •female, 26-year-old •car accident, TBI, spine injury Occipital bone fracture, subluxatio C0-1, C1-2 EDH Case 6 • before operation, halo vest Case 6 • DSC05299 Case 6 • DSC05307 Case 6 • after operation Case 6 • after operation Case 6 • 5 weeks later Case 6 • LP shunt Case 6 • after LP shunt Case 6 • DSC05936 Case 7 •male, 50-year-old •hydrocephalus •tumor – biopsy - GBM BARINA^VACLAV^^^=^^^^=^^^^ BARINA^VACLAV^^^=^^^^=^^^^ BARINA^VACLAV^^^=^^^^=^^^^ Case 7 •Torklidsen drainage • Torkildsen BARINA^VACLAV^^^=^^^^=^^^^ Case 8 •25-year-old man •shunt – 12-year-old + 4 revisions •shunt malfuction – signs of intracranial hypertension Case 8 Case 8 1 year ago Case 8 Novosad^Zbynek^^^=^^^^=^^^^ Case 8 after operation Case 9 •51 years old man, 8.5.2008 – headache, nausea, vomiting •decreased consciousness, confusion, stiff neck •CT exam – subarachnoid hemorrhage, acute hydrocephalus, DSA negative •external ventricular dreinage • Case 9 Case 9 •Second DSA - negative •19.6.2008 – implantation of a V-P shunt •22.6.2008 – sepsis, meningitis, explanation of the V-P shunt, EVD •Bacteriology negative, virology negative. Case 9 •4.7.2008 rebleeding, IVH. Case 9 MRI 8.8.2008 Case 9 •Rebleeding 17.8.2008 Case 9 •28.8.2008 Monostep 10 •3/2009 returned to work - buisnessman •only slight organic syndroma • Case 9 –Monostep/Dualswitch –a very large surface area to the CSF (overdreinage) –mechanism effectively immune against any of the problems associated with proteins or blood Case 9 • •