Managing Paediatric Hydrocephalus : The New Thinking

2011 Words9 Pages
MANAGING PAEDIATRIC HYDROCEPHALUS IN THE DEVELOPING WORLD
The New Thinking

INTRODUCTION
Hydrocephalus remains a signifiant challenge to neurosurgeons the world over, in particular the developing world. The mainstay of management remains the insertion of a ventriculo-peritoneal shunt (VPS). This method is expensive and has significant morbidity and mortality. An ideal treatment method would be to maintain a shunt free environment, however at the same time provide adequate and durable cerebrospinal fluid (CSF) diversion in a cost effective manner. We will explore a novel idea that has the potential to revolutionise the management of hydrocephalus, not only in third world countries, but the world on a whole.

CASE
A female neonate born premature at 32 weeks gestation was consulted on. While in the neonatal intensive care unit she developed multiple infections illnesses including meningitis. Her head circumference was noted to be increasing rapidly and was greater than the 90th centile for her age. She had a Computed Tomography (CT) scan of the brain and was noted to have hydrocephalus. She was referred to neurosurgery for assistance with her management. On examination, her head circumference was 40cm, fontanelles tense and she had the sunsetting sign. She moved all four limbs equally but was very lethargic. Her gestational age at that time was 34 weeks. Her Magnetic Resonance Scan showed massive communicating hydrocephalus. Due to her prematurity the plan was to

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