The human brain is surrounded by a fluid called cerebrospinal fluid (CSF) inside the skull and is floating in it. This fluid is necessary for the brain to maintain certain metabolic functions. More importantly, it protects the brain against trauma.
CSF is produced at a constant rate in chambers located in the inner parts of the brain, called the “ventricular system”, and is transmitted out of the brain through channels. It is also absorbed by some structures outside the brain. Conditions in which CSF volume increases are called “hydrocephalus” (HS). Hydrocephalus (Hydrocephalus) is derived from the Greek words “head” and “water”. The problem is mostly decreased CSF absorption.
CSF absorption is reduced for two reasons.
1- Inability of cells to absorb CSF (absorption disorder type HS, communicating HS).
2- Occlusion in the channels carrying CSF from where it is produced to where it is absorbed (occlusive type HS, non-communicating HS).
Treatment: There are two types of treatment methods.
1- Installing “shunt” systems that carry this fluid to another body cavity. This method can be used in both malabsorption and occlusive hydrocephalus. The basic idea is to transfer the excess CSF in the brain to another body cavity where it can be absorbed, with the help of a silicone tube. The cavity to be transferred is usually the patient’s largest body cavity, the abdomen. However, it can also be transferred to the heart or thorax.
2- Opening or bypassing the obstruction with endoscopic methods. As the name suggests, this method can only be used in patients with obstructive HS. It cannot correct the absorption disorder.
Shunt systems have the potential to cause long-term undesirable effects and mechanical-infectious problems. However, it can successfully treat all types of HS.
The biggest disadvantage of endoscopic methods is that their success rate is 75-80%. In addition, opened channels or new holes drilled to bypass the fluid may be re-clogged.
Below you can find the images of the “endoscopic third ventriculostomy” operation, which is the most frequently performed endoscopic surgery.
