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hydrocephalus(hi-dro-sef'a-lus) [? + kephale, head]
Several neurosurgical procedures are used to treat hydrocephalus. The most commonly used procedure has been to establish a conduit for CSF (called a “shunt”) from the ventricles of the brain to the peritoneal cavity or the right atrium.
The prognosis for an uncomplicated course is excellent when hydrocephalus is promptly treated by use of a surgically instituted shunt.
Vital signs and neurological status are monitored hourly or as necessary according to institutional protocol or the surgeon's directions. The infant's anterior fontanel is inspected for bulging and the head circumference measured (an indelible ink mark on the forehead ensures that all measurements are at the same location). The patient is positioned as directed by the surgeon, usually on the nonoperative side with the head level with the body. Fluid intake and output are monitored, and IV fluids are administered as prescribed. The patient is assessed for vomiting (an early sign of increased ICP and shunt malfunction). The patient is monitored for signs of infection (esp. meningitis) such as fever, stiff neck, irritability, or tense fontanels. The area over the shunt tract also is inspected for redness, swelling, and other signs of local infection. Dressings are checked for drainage and the wound redressed as necessary using aseptic technique. The patient also is observed for other signs and symptoms of postoperative complications, such as adhesions, paralytic ileus, peritonitis, migration of the shunt, intestinal perforation (with peritoneal shunt), and dehydration and septicemia. The infant's head, neck, and shoulders are moved as a unit with the rest of the body to prevent neck strain during position changes. The family is taught postoperative care measures, including watching for signs of shunt malfunction, infection, and paralytic ileus. Maternal bonding is encouraged. The parents are assisted to set goals consistent with the patient's ability and potential; the family should focus on the child's strengths rather than weaknesses. They should be made aware that shunts will need to be surgically lengthened periodically as the child grows, and that surgery also may be required to correct shunt malfunctions. Special education programs also are discussed with the parents; the infant's need for sensory stimulation appropriate to age is emphasized.
In congenital hydrocephalus, the faulty drainage of CSF from the ventricles of the brain often results in rapidly increasing head circumference, malformation of the skull (thin bone with widened fontanels and separated sutures), distended scalp veins, thin, shiny scalp skin, weak neck muscles incapable of supporting the head, and abnormal development of psychomotor and cognitive or language skills. In untreated cases of congenital hydrocephalus, the outcome is fatal in about half of the patients due to infection, malnutrition, or increased intracranial pressure. The parents of infants treated neurosurgically for congenital hydrocephalus are instructed in signs and symptoms that may indicate surgical complications: fever and headache, irritability, poor feeding, inconsolability.