infantile hydrocephalus in grownups - hydroassoc.org · conflicts of interest •i have a minor...
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Infantile Hydrocephalus In Grownups
Why it is different?
Why it is more difficult
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Harold L. Rekate MD
Director of the Chiari Institute Professor of Neurosurgery
Hofstra Northshore LIJ College of Medicine
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Conflicts of Interest
• I have a minor consulting arrangement with Codman Corporation for the development of shunt system
• I do not believe that this creates a conflict of interest in this presentation.
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Etiology Of Hydrocephalus
• Adults
–Tumor
–Hemorrhage
–Infection
• Infants – Same plus
–Congenital anomalies
–Venous hypertension
–Any or “all”
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How it Began
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After Consensus Meetings
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What Is Accomplished by Performing an ETV?
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Unique Pathophysiology
• Open Fontanel
• Distensible head
• Models of infantile hydrocephalus
• Pseudotumor in infants
• Hydrocephalus causes aqueductal stenosis
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“Normal Volume Hydrocephalus”
• One in five older children or adults with infantile hydrocephalus will have non-responding ventricles
• Pressures of 60 mmHg have been recorded without ventriculomegaly
• Essentially all have been turned away from ER as “crazy” or “drug seekers”
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Personality • Generally pediatric neurosurgeons see
themselves as managers of disease processes – Patients followed for decades
– In my practice average contact to surgery ratio 11:1
– Outcomes judged only after years or decades
• Generally general neurosurgeons see themselves as selecting patients for and performing surgery – Patients followed for weeks
– Average C:S ration 4.5:1
– Outcomes judged in acute situation
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Working with New Neurosurgeon
• Understand yourself
– Point of obstruction
– Headache vs. shunt failure
– Type of shunt
– Setting if programmable
• Understand what you want
• Trouble-shooting your problems
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CT Scans Vs Rapid sequence MRI
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Thoughts on the Present and Future of Pediatric Neurosurgery: Skull Base Surgery, Spinal
Instrumentation and Neuroendoscopy
An Essay for the 25th Anniversary of the Founding of the International Society for Pediatric Neurosurgery
Child Nerv Sys, 1997, 13:476-81
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Conclusions
• Find a system where neurosurgeons are aware of shunt problems
• Maintain a personal medical record
• Medic-alert bracelet if ventricles don’t enlarge
• Avoid Narcotics
• Be realistic but rapid sequence MRI is the best answer