Hydrocephalus shunts BY ALEX GRAY BME 281 What

Hydrocephalus shunts BY: ALEX GRAY BME 281

What is Hydrocephalus? � Neurological disorder where an excess of cerebrospinal fluid (CSF) builds up in the brain causing increased intracranial pressure (ICP) Ø Lateral ventricles produce CSF that is filtered through brain and ventricles to be reabsorbed, but is obstructed and/or not reabsorbed building up pressure

Causes of Hydrocephalus � Obstruction of CSF flow � Cysts � Tumors � Blood clots � Subarachnoid hemorrhage � Aneurysmal bleeding Ø Lack of reabsorption of CSF Ø Overproduction of CSF https: //en. wikipedia. org/wiki/Hydrocephalus

Side effects of hydrocephalus � Headaches � Seizures � Vomiting � Double vision � Impaired cognitive function � Memory loss � Short term memory problems http: //www. emsworld. com/article/11102879/can-hydrocephalus-cause-a-seizure

History of hydrocephalus treatment: � 1825 - various papers describing CSF flow and brain physiology � 1891 - Lumbar puncture was described as a treatment for hydrocephalus � 1908 - "Balkenstich Method” – hole made in corpus callosum to drain into subdural spaces � 1950’s- radioactive tracers to better understand actual flow of CSF � 1952 - shunt technology begins in its infancy using ball and spring valve http: //www. hydroassoc. org/shunt-systems/

Current Shunt technology � Three main components � Proximal catheter tubing � Valve and reservoir � Distal catheter Tubing Ø Various pressure setting based on patients needs Ø Low, medium, high Ø Many utilize ball and spring valve to regulate flow https: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 1765598/pdf/v 073 p 00 i 17. pdf

Different types of shunts Ø � Ventriculoatrial (VA) Ventriculoplueral (VPL) http: //www. medscape. com/viewarticle/558974_2 � Ventriculoperitoneal (VP)- Most common � Gravity assisted valve (GAV) � Programmable valve http: //auburnspine. com/disorder/brain_nph_treatment. html

Limitations � Failure rates as high as 40% in first two years � Obstruction � Infection within the first 2 years 10 -15% � Over-drainage Ø Require consistent revisions based on varying flow rates and pressure Ø Unpredictable and difficult to survey changing conditions

Future Technology � Smart shunt technology � Self correcting shunt � Ability to record and transmit data from persons brain Ø Material science advances to lower infection rate and obstruction rate Ø Different tubing and valve mechanisms http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 3642745/

Questions?

Bibliography � Lifshutz, Jason I. , and Walter D. Johnson. "History of Hydrocephalus and Its Treatments. " Neurosurgical FOCUS 11. 2 (2001): 1 -5. Web. http: //www. medscape. com/viewarticle/405733 � "Hydrocephalus. " Wikipedia. Wikimedia Foundation, n. d. Web. 27 Sept. 2016. https: //en. wikipedia. org/wiki/Hydrocephalus � Interactive, Rails. "Disorders Brain Treatment of Normal Pressure Hydrocephalus. " Auburn Spine and Neurosurgery Center. Auburn Spine and Neurology Center, n. d. Web. 27 Sept. 2016. http: //auburnspine. com/disorder/brain_nph_treatment. html � Lee, Won-Chul, Dae-Hee Seo, Il-Seung Choe, Sung-Choon Park, Young-Soo Ha, and Kyu Chang Lee. "A Comparative Result of Ventriculoperitoneal Shunt, Focusing Mainly on Gravity-Assisted Valve and Programmable Valve. " J Korean Neurosurg Soc Journal of Korean Neurosurgical Society 48. 3 (2010): 251. Web. http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 2966728/ � Browd, Samuelr, Barryr Lutz, and Pranav Venkataraman. "New and Improved Ways to Treat Hydrocephalus: Pursuit of a Smart Shunt. "Surgical Neurology International Surg Neurol Int 4. 2 (2013): 38. Web. http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 3642745/ � Pople, I. "HYDROCEPHALUS AND SHUNTS: WHAT THE NEUROLOGIST SHOULD KNOW. " Journal of Neurology, Neurosurgery, and Psychiatry. BMJ Group, Sept. 2002. Web. 27 Sept. 2016. https: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 1765598/pdf/v 073 p 00 i 17. pdf � "Shunt Systems. " Hydrocephalus Association. N. p. , n. d. Web. 27 Sept. 2016. http: //www. hydroassoc. org/shunt-systems/ � Allanach, Simon. "What Is Hydrocephalus? " What Is Hydrocephalus? N. p. , n. d. Web. 27 Sept. 2016. http: //hydrocephalus. allanach. dk/hydrocephalus � "Medscape Log In. " Medscape Log In. N. p. , n. d. Web. 27 Sept. 2016. � By Understanding Possible Shunt Complications, You Can Direct Your Care to Assess the Specific Problem, Whether It Be Initiating Treatment for an Infection or Recognizing the Need for Transport for a Possible Break in the Shunt Due to Rough Physical Activity or Trauma. As EMS Providers, We Encounter a Variety of Special Populations. Having a Little Insight into Them Will Allay Some of Our Anxiety That Comes from the Unknown. Next Time You Encounter a Situation in Which Our EMS Crew Did, Step Back, Take a Breath and Do What You Do Best-care for Those in Their Time of Need. "Can Hydrocephalus Cause a Seizure? | EMSWorld. com. " EMSWorld. com. N. p. , n. d. Web. 27 Sept. 2016. http: //www. emsworld. com/article/11102879/can-hydrocephalus-cause-a-seizure