1. Treatment of hydrocephalus at the Wessex Neurological Centre
Mr Ryan Waters PhD FRCS (Neuro Surg) Consultant Neurosurgeon

2. Philosophy To provide the highest quality service
Outcomes
Patient experience
Collaborative approach
Network partnerships with;
Our referring Trusts
Oxford Children’s Hospital (Children’s Hospital Network)
Third largest unit in the UK

3. Southampton Staff Owen Sparrow Nijaguna Mathad Aabir Chakraborty
Ryan Waters
Christine Ward (Nurse practitioner)
13 Paediatric Neurosciences nurses
Peter Gladwell (Surgical Practitioner)

4. Hydrocephalus
“An abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain”
but not the whole story?

5. Classification Non-communicating/obstructive CSF flow obstruction
Aqueduct stenosis
Tumour
Haemorrhage
Communicating
Absorption problem
Haemorrhage
Infection
Tumour
Inflammation
‘normal pressure hydrocephalus’
IIH

6. Common causes of hydrocephalus6

7. Causes
Post head injury
Tumour

8. Patient Assessment-History & Examination
Is the child Unwell?
Vomiting
Drowsiness
Headaches
School performance
Head circumference
Fontanelle
Bradycardia/apnoeas
Squint
Sunsetting 8

9. Treatment options Treat the underlying cause Temporary CSF drainage
Lumbar puncture
Ventricular tap
EVD
Endoscopic IIIrd ventriculostomy
Shunt VP VA
VPleural

10. ETV

11. Shunt

12. Shunt hardware

13. Proximal and Distal Tubing Selection
Antibiotic impregnated catheters
Bactiseal
Silverline
More than 20 studies on Bactiseal
Some evidence that Bactiseal reduces shunt infections
Need for a multicentre randomised controlled study - BASICS 13

14. Shunt Blockage
Southampton Children's Hospital

15. Shunt Malfunction 15

16. Shunt Disconnection
Southampton Children's Hospital

17. Southampton Children's Hospital

18. NB Facilitated by System with Reservoir
Diagnostic Shunt Tap
Aseptic Technique
Measure Opening Pressure
If Possible Remove Adequate Volume of CSF
Send Specimens to Chem, Micro & Culture
NB Facilitated by System with Reservoir
Southampton Children's Hospital

19. Normal Pressure Hydrocephalus
Generally seen in older adults
Communicating hydrocephalus
Clinical triad
Cognitive decline
Gait disturbance
Urinary incontinence
Ventriculomegaly on imaging

20. Investigation at WNC MDT with neurology, neuropsychology, neurosurgery
Assessment
Neuropsychology
Walking test
CSF infusion test
CSF drainage

21. Treatment at WNC VP shunt Programmable valve
Risk of overdrainage and subdural formation

22. Idiopathic Intracranial Hypertension
Not ‘hydrocephalus’ but often treated with a shunt
A venous disorder
Multidisciplinary approach; neurology, neurosurgery and neuroradiology
Venography, manometry and stenting where possible
but shunts still used to control ICP