Cerebrospinal fluid shunt, similar to the South-to-North Water Diversion Project, is to direct the cerebrospinal fluid in the ventricles to other parts of the body to restore the balance between cerebrospinal fluid secretion and absorption, so as to achieve the purpose of treating hydrocephalus. Recently, the Department of Neurosurgery of Shanghai Donglei Brain Hospital successfully treated a patient with hydrocephalus who had been in a coma for a long time, saving the patient's life through innovative surgical techniques and meticulous treatment plans.
The patient, Ms. Zhang (pseudonym), fell into a coma in June this year due to a head injury. The local hospital diagnosed a left temporal lobe intracerebral hematoma and brain herniation, and immediately performed hematoma removal and decompression surgery to remove the bone flap. After the surgery, Ms. Zhang's consciousness improved but remained hazy. Three months after the skull repair, she began to experience symptoms of hydrocephalus and her coma worsened. In response to this situation, the local hospital performed ventriculoperitoneal shunt and two adjustments, but the problem of hydrocephalus has not been effectively improved, and Ms. Zhang continues to be in a shallow coma. Ms. Zhang's family was so anxious that after many inquiries, she was transferred to Shanghai Donglei Brain Hospital. Faced with this complex and difficult case, after shunt valve manometry and detailed imaging examination, combined with the patient's clinical manifestations and medical history, the neurosurgery team of Donglei Hospital preliminarily diagnosed Ms. Zhang with "low-pressure hydrocephalus".
"Low-pressure hydrocephalus is a special type of hydrocephalus that is extremely difficult to treat." Tan Shubin, director of the Cerebrospinal Fluid Management Academic Center and director of the Neurorepair Academic Center of Donglei Brain Department, said that although Ms. Zhang had undergone shunt surgery, the results were not good. "In an easy-to-understand way, it is because the patient's brain has been pressed for a long time, and the elasticity has deteriorated, just like tofu has been pressed into dried tofu, and the intracranial cerebrospinal fluid pressure is not high, and there is no pressure difference, so hydrocephalus cannot flow out, just like 'Dayu water control' was not cured."
Based on Ms. Zhang's special case, considering the poor results of her previous surgery, Director Tan's team from Shanghai Donglei Brain Hospital reviewed her medical history, surgical records and current physical condition in detail, and decided to adopt a more refined and personalized treatment method, an innovative "negative pressure ventricular drainage" technology treatment, "In short, the tube is connected to the outside of the body, and negative pressure is formed by siphoning, so that the brain can change from dried tofu back to tender tofu, so that hydrocephalus can be treated by itself" Squeeze it out, and then put it in the abdominal cavity to continue draining. Tan Shubin told reporters. At the same time, the patient can also move freely during the drainage process and continue to rehabilitate.
On the first day after the external drainage, Ms. Zhang's consciousness improved significantly and she was able to answer the questions. Two days later, she was able to get out of bed and receive rehabilitation exercises with her support. With the deepening of treatment, Ms. Zhang's condition gradually stabilized, and her limbs became more and more comfortable. Thirty-three days after surgery, the shunt was successfully placed into the abdominal cavity, marking a complete success of the treatment.
The human brain tissue itself is immersed in a "liquid" called cerebrospinal fluid. Normally, cerebrospinal fluid (CSF) is a living water that is constantly being produced and absorbed in equal amounts, and the same amount is maintained over and over again. "Cerebrospinal fluid (CSF) relieves and protects brain tissue. But when its circulation is obstructed and it is not absorbed enough, it can cause hydrocephalus. Hydrocephalus is a condition in which cerebrospinal fluid accumulates too much in the ventricular system and causes a variety of subsequent symptoms. Tan Shubin introduced that after some patients have traumatic brain injury, because of cerebral hemorrhage and subarachnoid hemorrhage, the function of arachnoid particles to absorb cerebrospinal fluid may decrease, resulting in hydrocephalus. Hydrocephalus may cause symptoms such as headache, vomiting, vision loss, unsteady gait, urinary incontinence, cognitive decline, and if left uncorrected for a long time, it can cause functional impairment such as brain atrophy.
Hydrocephalus in adults may be caused by tumors, inflammation, hemorrhage, etc., especially a large amount of subarachnoid hemorrhage caused by severe cerebrospinal fluid infection and ruptured aneurysm, which is easy to develop secondary hydrocephalus. In addition, idiopathic normal-pressure hydrocephalus is often found in older people, and is often misdiagnosed as dementia. Hydrocephalus is often difficult to identify on its own, requiring a neurologist or neurosurgeon to confirm the diagnosis through symptoms and imaging. The average person does not need special measures to prevent hydrocephalus in their daily lives. Patients with a history of head injury, hemorrhage, infection, surgery, etc., should be cautious of the possibility of hydrocephalus and need to go to a specialist for further examination if they have symptoms such as cognitive deterioration, unsteady walking, and urinary incontinence.
Reporter: Li Yanli (chief)
Photographer: Li Yanli (Chief)
Editor: Hu Xiaofan
Editor in charge: Sun Chen (chief)
Final Review: Zhang Jing (Distinguished Chief)
Please indicate that it is from the official WeChat of "Green Qingpu".