The patient spends the first day of the postoperative period in neuroresuscitation. This is necessary in order to ensure the most careful monitoring of the patient and to notice the deterioration in time if it happens. If necessary, the length of stay in intensive care is extended.
If the postoperative period proceeds without complications, then a day after the operation the patient is transferred to the neurological department.
In the next week after surgery, 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 infection.
Other medicines are also prescribed:
- with high blood pressure – mannitol in combination with other diuretics.
After the operation, an MRI is done to the patient – the first time a day after the operation, if necessary, the analysis can be scheduled again. You must make sure that the shunt is in place, located freely and performs its function.
On the second day after surgery, patients undergo MRI of the brain. The doctor looks for hemorrhages or areas of ischemia. Then a duplex scan is performed to determine the adequacy of the volume of blood flow after shunting the head.
Surgery on the brain is always extremely complex, responsible for the doctor. At the rehabilitation stage, it is recommended to strictly adhere to the rules that the doctor will tell. This will provide an opportunity to return to normal life as soon as possible. In 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 swelling;
- do not play sports;
- do not carry weights over 2-3 kg;
- to be in the fresh air daily.
Brain bypass surgery is a complex operation. The patient is threatened with bleeding, thrombosis, infection, inadequate responses of the body to anesthesia. It is always necessary to remember the risk of developing epilepsy, stroke, and a clot of the shunt.
- How is the
- Features of shunt systems with hydrocephalus
- Contraindications and rehabilitation
- Postoperative rehabilitation and prognosis
- To whom and when this procedure is necessary
- Preparatory stages before the procedure
- Carrying out the procedure using hydrocephalus as an example
- Not everyone will do the surgery.
- Preparing for an operation
- Brain bypass with hydrocephalus – what is it?
- Types of operations
- Techniques for conducting
- How are children, adults and newborns doing surgery?
How is the
The procedure is performed under general anesthesia. Before the operation, it is necessary to conduct certain examinations to select the most suitable bypass methods:
- Blood and urine tests.
- Magnetic resonance thermogram.
- CT scan.
- Ultrasound examination of arteries.
As soon as the diagnostic results are known, the patient confirms in writing the consent to surgery. At the same time, he describes possible risks and complications. If brain bypass surgery is necessary in newborns, parents must give consent.
Before the operation itself, the patient needs to take a shower and wash his hair. In some cases, shaving is required. All foreign objects (earrings, glasses, piercings, dentures, contact lenses) are removed from the head. A few weeks before the scheduled operation, the patient is advised to avoid drinking alcohol, smoking, taking non-steroidal anti-inflammatory drugs. Eight hours before the procedure, the patient does not eat anything (it is allowed to drink water in a limited amount).
Bypassing the vessels and arteries of the brain allows you to create a new branch of blood flow that bypasses the problem vessel. A vein or an artificially created blood vessel is used as a shunt. It is sewn in behind the place of damage or in front of it. After this operation, blood circulation resumes in a new area.
Hydrocephalus bypass surgery is as follows:
- The patient is covered with sheets and left open where the incisions will be made.
- Locations of cerebrospinal fluid bypass surgery are lubricated with an antiseptic.
- A trepanation hole is made through which a drainage tube (shunt) is brought to the brain.
The abduction of the tube into the abdominal cavity is extremely rare, since it is associated with a high risk of complications. It is considered safer to ventriculoatrial bypass, 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 a shunt in the soft tissues, synchronizing the path of the drainage tube with the arteries. Next, the shunt is installed in the required ventricle through the trepanation hole. Modern doctors use drainage tubes equipped with special valves to prevent the backflow of cerebrospinal fluid, which provides additional reliability and functionality of the operation. Shunting in the same way is carried out in children.
Features of shunt systems with hydrocephalus
A 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 brain, where cerebrospinal fluid accumulates in excess. The second end of the catheter is installed in the storage tank.
The system also has a valve for regulating the outgoing fluid. The cerebrospinal fluid is directed through the outer part into the chest or abdominal cavity. The external section is a part of the shunt system that communicates with the internal catheter to the chest or abdominal cavity. This part of the shunt is performed by neurosurgeons subcutaneously and is not visible from the outside.
With dropsy, you can use these shunts:
- ventriculoatrial – cerebrospinal fluid enters the atrium;
- ventriculoperitoneal – drainage occurs in the abdominal cavity.
An extremely important structural element is the valve. It allows the flow of cerebrospinal fluid in the right direction. The valve can regulate the volume of fluid entering the tank.
Contraindications and rehabilitation
Patients may be denied surgery for 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.
Patient recovery requires certain medications (antibiotics, painkillers). If the pressure is increased, diuretics are used in combination with Mannitol.
In addition, it is necessary:
- Refuse work requiring increased concentration of attention and quick reaction.
- Avoid overwork and heavy physical exertion.
Postoperative rehabilitation and prognosis
Assessment of therapy is carried out the next day. An MRI is done to the patient, and repeated examinations are carried out seven days later, and immediately after the patient’s discharge.
Rehabilitation of a patient after brain bypass surgery has been performed includes taking medications, giving up bad habits, observing sleep and rest.
Doctors check the shunt from time to time and replace it if necessary. The procedure is necessary in connection with 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 – it is impossible to predict.
When the system is clogged and cerebrospinal fluid drainage is impaired, patients receive urgent surgical care – replacement of the drainage 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 catheters must be carefully monitored. Such patients are forced to constantly visit the clinic for revision of the shunt system. After surgery, it is advisable for patients to abandon bad habits, eat right, protect themselves from stress.
After discharge, you must follow all the instructions of your doctor. The medications needed in the postoperative period after bypassing the vessels of the brain, and their dosage, is also prescribed by the doctor.
To avoid complications, you must strictly follow the recommendations:
- restriction or prohibition of homework;
- a ban on driving;
- lifting or moving objects heavier than 2 kg is not allowed;
- restriction on physical activities. It is necessary to start with walks lasting 10-15 minutes, gradually increasing the load;
- swimming in open water is not recommended
- proper nutrition recommended.
After some time, an additional hardware examination will be required to analyze the patient’s condition. Based on the results of the survey, some restrictions can be relaxed.
To whom and when this procedure is necessary
This operation is indicated for patients in the diagnosis of the following pathological changes in the brain:
- in case of diagnosing a patient with a brain tumor and atherosclerotic damage;
- in the diagnosis of aneurysm, which is not amenable to treatment by intravascular or open methods;
- if it is not possible to prevent the onset of stroke with medications;
- diagnosis of extended stenosis, as well as occlusion of arteries and subsequent violation of venous blood flow in the brain;
At the early stages, doctors eliminate all the root causes of a malfunction in the bloodstream, and with a stroke, they prescribe a course that facilitates the patient’s symptoms.
Preparatory stages before the procedure
Before the operation, for 2-3 weeks the patient should stop smoking and drinking alcohol, stop taking non-steroid medications.
Before the operation itself, the patient undergoes a cardiogram examination, fluorography, and urine and kcal for analysis. In addition, the doctor may additionally prescribe the following examination procedures:
- MRI and CT, as well as intra-arterial angiography – all these examination methods can determine the exact location of stenosis, clogged arteries;
- investigation of the state of arteries using ultrasound – this method will diagnose the general condition of the vessels of the brain.
Carrying out the procedure using hydrocephalus as an example
In the event of a failure in the outflow of cerebrospinal fluid in a patient, a disturbance such as hydrocephalus, a complex theology of the disease, can develop in the brain, which in the absence of proper treatment can lead to the development of serious consequences.
Most often, such irreversible processes, changes and disorders are neurological and mental illnesses.
Today, the most common way to treat hydrocephalus is bypassing the brain – in this case, doctors use a special hose – a shunt made of silicone, which allows fluid to be removed from the ventricles of the brain to another place in the body, for example, into the chest or abdominal cavity, bladder.
Doctors use such varieties – shunting with hydrocephalus:
- ventriculoperitoneal intervention;
- ventriculoatrial intervention.
In the first case, the doctor makes a hole in the cranium – a tube is inserted into it, one end is brought into the cavity of the ventricles of the brain, and the second is removed into the peritoneal cavity. Excess fluid is excreted, but this method is marked by a high risk of infection, and, accordingly, the development of complications.
The second method of operation is not so dangerous – so the mechanism and the system of shunts are more complex in structure, and are equipped with special valves, which determines more efficient operation, reliability, full operation.
This system requires regular replacement with a frequency of once every 6 months – an introduced shunt in the head will allow the patient to provide a normal life, without problems and complications. The main condition is to monitor the condition of the shunt.
Not everyone will do the surgery.
Speaking of contraindications to this procedure, brain bypass grafting, with a shunt to the peritoneum or other areas, is not performed if an infection is currently developing in this area.
This also applies to cases where the infection affects the scalp, other parts of the body through which the bypass systems will be conducted, or there is an infectious lesion of the lining of the brain, ventricles, and bloodstream.
Also, this procedure is contraindicated and is not performed if the patient is diagnosed with a heart muscle defect, other severe cardiopulmonary pathologies and disorders.
Violation of cerebral circulation can lead to irreversible changes in the human body. Atherosclerosis is considered the main cause of the disorder. Partial or complete blockage of blood vessels leads to a disruption in the supply of oxygen and nutrients to brain cells. The result of such “starvation” may be ischemia, which destroys brain cells.
Brain vascular bypass surgery performed on time will help prevent ischemic stroke leading to death.
Preparing for an operation
Direct preparation for bypass vessels of the brain begins with laboratory and hardware examinations, which will allow you to choose the most convenient method of operation. After receiving the examination data and appointing the day of the operation, the patient will need to read and sign a consent document for surgical intervention. Brain bypass surgery is a complex procedure, and postoperative complications can occur.
Preparatory measures before the operation are not complicated. It is necessary to take a shower twice (before bedtime and before surgery in a hospital), wash your hair twice. You may need to shave your hair (performed by a nurse in a hospital setting). All foreign objects from the head, such as piercings, earrings, removable dentures and more, need to be removed. It is also forbidden to use the means of communication after the operation, so they must also be deposited.
Damage (clogging) of the arteries of the brain occurs most often in bending or branching them. Most often, the middle cerebral artery comes under attack.
When performing a brain vascular bypass surgery, access to the cerebral artery is obtained. First, a bone fragment is cut out in the cranium and a shunt is sewn through this hole to the damaged vessel. If the damage is not large, then the surface arteries of the soft tissues of the head act as a shunt.
The mechanism of brain bypass surgery
If the artery with high throughput is damaged, then a part of a vein or artery taken from another part of the body is used as a shunt. It is sewn to the carotid artery on the neck. Thus, bypass blood flow is created to feed brain cells.
After the operation, the patient will spend some time in the intensive care unit to monitor the condition of the body.
To check the state of the brain, the doctor will conduct a simple test. The next day after the operation, it is recommended to conduct an MRI (magnetic resonance imaging) for a hardware check of the state of the vessels, to exclude complications or hemorrhage. Before discharge, a scan is performed to monitor the operation of the shunt and assess the nature of the blood flow.
Brain bypass with hydrocephalus – what is it?
Hydrocephalus is an excess accumulation of fluid (cerebrospinal fluid) in the cavities of the brain. It can be external (affected by the subarachnoid space), internal (affected by the ventricles) or general / mixed (both are affected). The ventricles are the internal cavities of the brain, the walls of which produce a special fluid – cerebrospinal fluid, which serves to power the deep layers of the brain. The subarachnoid space separates the layers of the brain substance.
with hydrocephalus (right), excess cerebrospinal fluid causes increased pressure in the skull
According to the type of message of the ventricles of the brain and subarachnoid space, hydrocephalus is open (message saved) and closed or occlusive (message is broken). It is in the second case that shunting is necessary.
Especially important is the speedy conduct of the operation with congenital hydrocephalus, since it leads to a serious developmental delay, which will be difficult to correct subsequently. The decision on the operation of newborn children should be made by parents, this option can be recommended to them only after confirming the diagnosis by CT or MRI. Sometimes you can do conservative therapy – 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 with hydrocephalus. The operation is infrequent 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 – increased intracranial pressure.
The tumor can also, along with ischemia, trauma and infection, cause adult hydrocephalus. She is also treated promptly by installing a shunt. This allows patients in almost 100% of cases to return to work or significantly improve their quality of life.
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Types of operations
In modern neurosurgical practice, the following options for brain bypass surgery with hydrocephalus are possible:
The formation of porencephaly. This type of intervention is a combination of the ventricle and subarachno >
example of ventriculoperitoneal shunting
Techniques for conducting
The operation is performed under general anesthesia. The patient is covered with sheets with the exception of the incision. All areas subject to surgery are treated with aseptic drugs. The surgeon seals the proposed shunt path with a medical transparent film.
A catheter can be placed in the non-brain area (when using the abdominal cavity) or in the ventricles of the brain (when using a heart bag). After its fixation, the surgeon cuts the path of the shunt in the subcutaneous tissue. It is brought to the brain through a trepanation hole.
The risk of undesirable consequences after surgery is great enough. The need for re-intervention in the first year after shunting occurs in 20% of cases. Nearly half of patients undergo multiple lifelong surgeries.
The most common complications are:
- Mechanical dysfunction – that is, the termination of the effective operation of the shunt. It arises both as a result of natural changes in the body (with the growth of the child who underwent surgery, lengthening of the artificial canal is also necessary), and as a result of adhesive, inflammatory, tumor processes or insufficient qualification of the surgeon. Complications require shunt replacement.
- Infection. It can occur as an exacerbation of the inflammatory process of the brain or as a result of infection. In 90% of cases, the pathogen is staphylococcus bacteria. For prevention, it is necessary to take antibiotics for any inflammation, including caries. Conservative treatment is rarely successful, most often you have 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 fixed by replacing the valve. In rare cases, the ventricles pathologically change, subside, take the form of a gap. Even a small jump leads to nausea, vomiting, dizziness. Treatment is unpromising.
- 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, drainage and replacement or reprogramming of the valve to a higher pressure are performed.
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 way 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 affected tube of the brain and the right atrium or peritoneum are connected with a special tube (shunt). Thus, the outflow of fluid is ensured, the ventricle returns to its normal size.
There are several methods for brain bypass surgery:
- Ventriculo-atrial (connection of the ventricle with the right atrium, less often with the left);
- Ventriculo-peritoneal (connection of the ventricle with the peritoneum);
- Ventriculo-cisternostomy (connection of the ventricle with tanks of the arachnoid membrane of the brain);
- Subduro-peritoneal (connection of the space under the dura mater with the peritoneum);
- Ventriculo-urethral (a rare type of shunting, connection of the ventricle to the urethra).
Which method will be applied in each case depends on:
- features of the course of the disease in the patient;
- concomitant diseases;
- general condition.
How are children, adults and newborns doing surgery?
During a brain bypass surgery, the patient is injected with a system of tubes and valves that ensure normal cerebrospinal fluid outflow.
These tubes are hereinafter:
- do not impede movement;
- do not disturb blood flow;
- can significantly improve the condition of the patient.
In adults, they are established 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, brain development is impaired, which leads to deviations in the psyche and mental development of the child.
The longer hydrocephalus persists, the less likely the child will have a 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, so 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 particular ventricle the violation occurred.
Bypass surgery normalizes the outflow of cerebrospinal fluid from the ventricles of the brain, due to this, intracranial pressure also normalizes, which allows you to get rid of headaches.
A crowded ventricle ceases to squeeze neighboring brain structures, so the neurological disorders caused by hydrocephalus disappear, and lost motor functions are restored.
In newborns, due to physiological characteristics, overflow of the ventricles causes an increase in the size of the head, accompanied by compression and atrophy of the brain.
In the future, this threatens mental retardation and severe motor impairment in the child.
Timely bypass surgery allows you to stop this process. The children’s brain is very plastic, and the functions of damaged areas of the brain are quickly restored, the child’s development 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 return to normal.
Before performing a bypass operation:
- The patient will be assigned a series of tests. Violations of 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 cerebrospinal fluid outflow in the ventricles, and according to its results, the question of the need for surgery is resolved.
- Other studies include cerebral angiography (an X-ray examination of blood vessels, may be performed together with an MRI or CT scan) to identify possible blood flow disorders in the brain, the risk of bleeding during surgery, and features of the location of the vessels.
- Additionally, a study of the cavity into which it is planned to withdraw cerebral fluid is carried out. If the atrium is chosen in this capacity, it is necessary to do an ECG, echocardiography, dopplerography of the heart to determine how safe such an operation is.
- If it is planned to connect the affected ventricle with the peritoneum, then an ultrasound scan and an MRI of the abdominal cavity are performed to identify possible contraindications for surgery.
If the operation is already scheduled, then the patient must:
- Take a shower twice – on the evening before the operation and in the morning on the day of the operation, while always wash your hair thoroughly.
- The last meal should be eight hours before surgery, 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.
- It is necessary to remove glasses, contact lenses, dentures, earrings and piercings – during the operation, there should not be any foreign objects on the head.
- All jewelry, a mobile phone and other valuables must be given in advance to relatives or taken to a left-luggage office.
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