Suvremene mogućnosti liječenja hidrocefalusa dječje dobi

master's thesis

• Title (english): Modern treatment methods for pediatric hydrocephalus
• Author: Dorian Karuc
• Mentor: Goran Mrak (mentor)
• Committee member: Goran Augustin (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Goran Mrak (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2020-09-11, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Hidrocefalus je poremećaj u kojem dolazi do pretjeranog nakupljanja cerebrospinalnog likvora unutar ventrikularnog sustava mozga što se obično očituje povišenjem intrakranijalnog tlaka i proširenjem ventrikula. Hidrocefalus nastaje kao rezultat brojnih
patoloških procesa koji dovode do poremećaja fiziologije cerebrospinalnog likvora. Njihova raznovrsnost ujedno uvjetuje veliku razliku u njegovoj prevalenciji između djece u slabije razvijenim i visoko razvijenim zemljama. Neki od najčešćih kliničkih znakova hidrocefalusa kod djece mlađe od dvije godine su: povećani opseg glave, izbočenje anteriorne fontanele, dilatacija superficijalnih vena glave, „znak zalazećeg sunca“, papiloedem i Macewenov znak. Kod starije djece s potpuno sraslim kostima
lubanje, simptomi i znakovi hidrocefalusa istovjetni su onima povišenog intrakranijalnog tlaka. Postoji nekoliko podjela hidrocefalusa. Najpoznatija je ona na nekomunicirajući i komunicirajući oblik. Nekomunicirajući hidrocefalus uzrokovan je sa
blokadom protjecanja cerebrospinalnog likvora od ventrikula prema subarahnoidalnom prostoru. Prvi terapijski izbor za ovaj tip
hidrocefalusa je endoskopska treća ventrikulostomija kojom se postiže izravna komunikacija trećeg ventrikula sa subarahnoidalnim prostorom i na taj način potpomaže prirodna resorpcija likvora. Komunicirajući hidrocefalus uzrokovan je poremećajem apsorpcije cerebrospinalnog likvora uz održanu komunikaciju ventrikularnog i subarahnoidalnog prostora.
Ventrikuloperitonealna drenaža, kojom se likvor preko sustava katetera odvodi iz lateralnog ventrikula u peritonealnu šupljinu, danas se koristi kao prvi terapijski izbor u liječenju komunicirajućeg hidrocefalusa. U slučaju postojanja kontraindikacije koja
onemogućuje ugradnju ventrikuloperitonealnog šanta na izboru su nam i metode ventrikuloatrijalne i ventrikulopleuralne drenaže kao i privremene terapijske metode kojima se prolongira vrijeme ugradnje šanta dok se ne ostvare zadovoljavajući uvjeti. Te metode uključuju vanjsku peritonealnu drenažu, ventrikularni rezervoar i ventrikulo-subgalealni šant.

Abstract (english)

Hydrocephalus is a condition in which an excessive accumulation of cerebrospinal fluid occurs within the ventricular system of the brain which is usually manifested by an increase in intracranial pressure and dilation of the ventricles. Hydrocephalus occurs as a result of numerous pathological processes that lead to disorders of the physiology of the cerebrospinal fluid.
Their diversity also causes a large difference in hydrocephalus prevalence between children in less developed and highly developed countries. Some of the most common clinical signs of hydrocephalus in children under the age of two are: increased head circumference, protrusion of the anterior fontanelle, dilatation of the superficial veins of the head, "setting sun sign", papilloedema and Macewen's sign. In older children with closed skull sutures, the symptoms and signs of hydrocephalus are identical to those of elevated intracranial pressure. There are several classifications of hydrocephalus. Best-known is the one that differentiates non-communicating and communicating form. Noncommunicating hydrocephalus
is caused by blockage of cerebrospinal fluid flow from the ventricles to the subarachnoid space. The first therapeutic choice for this type of hydrocephalus is an endoscopic third ventriculostomy in which direct communication of the third ventricle with the subarachnoid space is achived and therefore the natural resorption of the cerebrospinal fluid. Communicating hydrocephalus is caused by impaired absorption of cerebrospinal fluid with maintained communication of the ventricular
and subarachnoid space. Ventriculoperitoneal drainage, by which the cerebrospinal fluid is drained through a catheter system from the lateral ventricle into the peritoneal cavity, is today used as the first therapeutic choice in the treatment of communicating hydrocephalus. In case of contraindication that prevents implantation of ventriculoperitoneal shunt there is
also the choice of ventriculoatrial and ventriculopleural drainage methods as well as temporary therapeutic methods that
prolong the time of shunt implantation until satisfactory conditions are achieved. These methods include external peritoneal drainage, ventricular reservoir, and ventriculo-subgaleal shunt.

• Keywords: hidrocefalus; ventrikuloperitonealni šant; endoskopska treća ventrikulostomija
• Keywords (english): hydrocephalus; ventriculoperitoneal shunt; endoscopic third ventriculostomy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:713019
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-04-12 09:19:09