hydrocephalus

(hī″drō-sef′ă-lŭs)

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[hydro- + -cephalus]
The accumulation of excessive amounts of cerebrospinal fluid (CSF) within the ventricles of the brain, resulting from blockage or destruction of the normal channels for drainage of CSF. Common causes include congenital lesions (such as spina bifida or aqueductal stenosis), traumatic lesions, neoplastic lesions, and infections such as meningoencephalitis. Sometimes the accumulated fluid leads to increased intracranial pressure (ICP).
SYN: SEE: hydrencephalus
SEE:
hydrocephalic (hī″drō-sĕ-fal′ĭk)
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, adj.

TREATMENT
Several neurosurgical procedures are used to treat hydrocephalus. The most commonly used procedure has been to establish a shunt for CSF from the ventricles of the brain to the peritoneal cavity or the right atrium.

PROGNOSIS
The prognosis for an uncomplicated course is excellent when hydrocephalus is promptly treated with a shunt.

PATIENT CARE
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.

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