Neurosurgery

1/22/2009

Pediatric Surgery Care

ระบบประสาท

Bby By

Susheewa Wichaikull

• Hydrocephalus ( อุทกเศียร) • Meaningocele • Spina Bifida

Hydrocephalus Hydrocephalus is commonly known as 'water on the brain'. A watery fluid , known as cerebro-spinal fluid or CSF, is produced constantly inside each of the four spaces or ventricles inside the brain.

พยาธิสรี รภาพ Choroid Plexus ใน Ventricle(Lateral) Foramen of Monro

Third Ventricle,Fourth Ventricle Foramen of Luschka Foramen of Magendie Cistena Magna

Arachnoid ไหล Flow ไปรอบสมองและไขสันห Arachnoid Villi ดูดซึมเข้ากระแสเลือด

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What causes Hydrocephalus? The condition is caused by the inabilit of CSF to drain into the bloodstream. 1. The CSF abnormally flows through narrow pathways from one ventricle to the next. Such as Tumor obstruction , Dandy Walker Cy brain heamorrhage ,and so on. 2.

Communicate Hydrocephalus

The CSF is not absorbed into the bloodstream and recirculates well.Such as septicemia like Meaningitis,from mother disease , Genetic and

Sign and Symtom Acute Hydrocephalus Increasing Intracraneal Pressure • fatigue

• general malaise •visuo perceptual problems •visuo-perceptual •behavioural changes •Setting sun sign •Macewen’s sign

Cronic Hydrocephalus

How is Hydrocephalus Treated? Some forms of hydrocephalus require no specific treatment. Other forms are temporary and do not require long-term treatment However, treatment. However most forms do requ treatment, and this is usually surgical. Drugs have been used for many years but may have unpleasant side effects and are not often successful.

The usual treatment is to insert a shunting device. Shunting controls the pressure by draining excess CSF, so preventing th condition the c nditi n b becoming c min worse. rs An alternative treatment may be third ventriculostomy. This treatment if successful, avoids the need for a sh

What is a Shunt? A shunt is simply a device which diverts the accumulated CSF from the obstructed pathways and returns it to the bloodstream.

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It is inserted surgically so that the upper end is in a ventricle of the brain and the lower end leads either, • into the heart (ventriculo-atrial) • into the abdomen (ventriculoperitoneal). • into the outer lining of the lungs (ventriculo-pleural shunt

Treatment •Ventriculo-atrial shunt • Ventriculo-peritoneal shunt h

What are the effects of hydrocephalus? There can be learning difficulties associated with hydrocephalus such as problems with concentration, reasoning and short-term y Hydrocephalus y p can also result in memory. subtle effects: giving problems with

•Ventriculo-plural shunt

co-ordination, motivation and organisational

• Ventriculo-atrial shunt

or early puberty in children, may also occur.

skills. Physical effects such as visual problems,

•SB with Medication

Nursing Care • Observe to precaution sign vomiting, headach, dizziness, photophobia (sensitivity to light) and other visual disturbances, drowsiness and fits

•Precaution In shunt infections •Observer Nuro sign , Vital sign

• Semi Fowler’s position • To measure abdomen and Head curcumcission

Spina Bifida Spina Bifida is a fault in the spinal column in which one or more vertebrae (the bones which form the backbone) faill to form properly, leaving fa leav ng a gap or spl split, t, causing damage to the central nervous system.

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Spina Bifida The central nervous system and spine develop between the 14th and 28th day after conception. Spina bifida occurs when there is a failure of development o the boney canal which surrounds the bra and spinal cord.

Types of Spina Bifida There are three main types of spina bifid Spina Bifida Occulta (hidden) There is a slight deficiency in the formation of (usually) one of the vertebrae. It may have visible signs of a dimple or small hair growth on the back

Spina Bifida Cystica (cyst-like) The visible signs are a sac or cyst, rather like a large blister on the back, covered by a thin layer of skin. There are two forms:

PIDEMIOLOGY: • incidence: 1-2/1000 live births (of spina bifida cystica) •age of onset:less than 26 days gestational age g g •risk factors: 1. Genetic 2. Nutritional and Environmental Factors 3. Drugs

Meningocele

Meninggomyelocele and eningoencephalocele A neural tube defect affecting g the spine resulting in the herniation of the meninges through a vertebral defect in the lumbar region.

TYPES: 1. Posterior Meningocele •most common type of meningocele •hernia contains no neural tissue p j externally y through g a •projects defect in the posterior aspect of the vertebral arch •usually covered by a thick -> thin layer of skin or membrane •may or may not leak CSF •usually not associated with

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2. Anterior Meningocele •uncommon type of meningocele

Treatment

•hernia contains no neural tissue •projects internally through a defect in the anterior aspect of the vertebrae t b int into th the p pelvis l is •complications include: constipation and/or bladder dysfunction females may have associated anomalies of the GU tract such as retrovaginal fistula ,vaginal septa .

A defect which also includes a small, moist sac (cyst) protruding through the spinal defect, containing a portion of the spinal cord membrane (meninges), spinal fluid, and a portion of spinal cord and nerves is called a meningocele, myelomeningocele, or meningomyelocele.

*Surgical treatment is needed to repair the defect and is usually done within 12 to 24 hours after birth to prevent infection, swelling, and further damage.

Nursing Care • Decreasing risk factor in pregnancy such as sepsis and folic acid deficiency The long-term result depends on the condition of the spinal cord and nerves. Outcomes range from normal development to paralysis (paraplegia). Infants may require about 2 weeks in the hospital after surgery.

• Prevention rupture of cyst • Crede’s maneuver after void •rectal exercise • prevention pressure sore

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