الفهرس 
Pathophysiology of HydrocephalusOnly 14 pages are availabe for public view
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Abstract
Hydrocephalus is a disturbance of cerebrospinal fluid (CSF) formation, flow, or absorption, leading to an increase in volume occupied by this fluid in the central nervous system. It is either communicating or non-communicating.
Surgical treatment is the preferred therapeutic option in patients with hydrocephalus.
Ventricular shunt placement for treating hydrocephalus is one of the most common neurosurgical procedures. Ventriculo-peritoneal (VP) shunt placement is the mainstay of treatment for hydrocephalus in both adult and pediatric patients.
Despite advances in shunt catheter materials and the valves used, there remains a high rate of shunt failure.
The most common cause of shunt malfunction is the proximity of the choroid plexus and catheter tip which lead to occlusion of ventricular catheter.
To minimize this problem, surgeons attempt to place the ventricular catheter away from the choroid plexus in the frontal horn, above the foramen of Monro, or in the occipital horn, a task most often achieved using anatomical landmarks.
In the early 1990s, endoscopes became available for use in shunt placement surgery. This allows visualization inside the ventricle so that the catheter can be placed away from the choroid plexus. Proximal catheterization failure is believed to be the result of obstruction of the catheter by the choroid plexus.
Optimal catheter placement can reduce proximal catheter failure. It has been reported that placement of ventricular catheters with stereotaxic, ultrasound, and endoscopic methods can help to reduce proximal catheterization failure
There are numerous publications in the literature comparing endoscopic assistance or image guidance to free hand ventricular catheter placement.
By comparing endoscopically versus non-endoscopically placed ventricular catheters, data has shown that endoscopic ventricular catheter placement reduces the odds of proximal obstruction, although it did not decrease the overall failure rate.
This study was an analytical study conducted on (60) patients with hydrocephalus undergoing VP shunt were randomly classified into 2 groups, (30) with free hand insertion and the other (30) with endoscopic guided insertion.
The study was conducted at Benha University Hospital and El-Mansoura New General Hospital. from July 2016 to July 2018
All patients with hydrocephalus whether communicating or non-communicating, were included in the study without privilege to age and gender; patients with intra ventricular hemorrhage or infection, medically unfit and recurrent were excluded.
All patients involved in this study were subjected to:
A. Preoperative assessment: Complete medical history, general examination , neurological examinations and CT ± MRI brain.
B. Operation:
1) Pre-operative preparation:
2) Intra-operative assessment:
• The following data were reported:- Time of operation and risks associated with endoscopic shunt placement.
C. Post-operative management:
All patients were assessed postoperatively:
1. Clinically focusing on postoperative occurrence of Neurological deficits, Seizures, Vomiting, CSF leak, Shunt failure, and Shunt infection.
2. Radiological assessment (CT ± MRI) to demonstrate proper catheter placement, and exclude complications.
We adopted Yim, et.al 2016 grading system to analyze ventricular catheter placement on postoperative CT imaging.
There is significant statistically difference (P value = 0.001*) in accuracy of catheter tip placement between two groups regarding G1, also statistically significant difference (P value = 0.005*) regarding G2 and statistically significant difference (P value = 0.009*) regarding G4, this statistically significant difference is for Endoscopic group.
As regard our study there was statistically significant difference (P value = 0.010 ) regarding Subgalial collection, Infection and Malfunction between two groups, there is no statistically significant difference regarding Vomiting, Fits, SD Hygroma , Fever, SDH and Pneumocephalous between two groups .
Mortality was zero in this study.