Gichuhi, M. Kinuthia (1989) Complications of Ventriculoperitoneal Shunts in Management of Congenital and Acquired Hydrocephalus as seen at Kenyatta National Hospital from January 1983 to December 1987. Masters thesis, University of Nairobi.
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Abstract
Hydrocephalus is an excessive accumulation of cerebraspina1 fluid (CSF) within the head due to disturbance of its secretion, its flow, its absorption or compensatory to loss of neural tissue. The latter type is of no surgical importance since there is no increase in the total volume of the intracranial contents and no rise in intracranial pressure. Ventriculo-peritoneal shunting of CSF is a procedure used in management of hydrocephalus. CSF is shunted through a tube inserted into none of the lateral ventricles to the peritoneal cavity. A one way mechanical valve is interposed along the course of the conducting tubing to regulate the rate of flow of the CSF. In the standard procedure a burr-hole is made at the postero-inferior aspect of the right parietal eminence via a hockey-stick skin incision. A small part of the dura is incised and the ventricular tube inserted. Another incision about 2.5 cm is made 2.5 cm below and parallel to the subcostal margin at mid clavicular line and the peritoneum exposed. The tube is threaded subcutaneously by rail-loading from the scalp incision to the subcostal incision. The breast is avoided when inserting the rail loading introducer such that the tract does not lie beneath the nipple. The peritoneum is opened after inserting a purse string suture and the distal end of the tube is placed in the suprahepatic space. The peritoneum is closed by tying the purse string around the tube, care being taken not to make it too tight as not to occlude the tube. The scalp and the abdominal incisions are then closed in layers. It is important when inserting the shunt to make sure the mechanical valve is placed in the scalp part of the tract so that functioning of the system can be tested without opening the wounds. This is done by compressing the collapsible part of the valve against the skull and its filling or non-filling can be ascertained. This is a retrospective study over a period of 5 years from January 1983 to December 1987, to determine the complications encountered in cases that had ventriculo-peritonea1 shunting procedures for management of both acquired and congenital hydrocephalus at Kenyatta National Hospital. Patients who had their initial shunts inserted before this period but required revision at any time during this period under study are not included. Also not included in this study were patients offered other types of shunting procedures? Kenyatta National Hospital is situated in Nairobi, the capital of the Republic of Kenya. It is a teaching Hospital and the only public Hospital in the Republic with a Neurosurgical Unit hence all cases requiring Neurosurgical management are referred to this unit from all over the Republic.
| Item Type: | Thesis (Masters) |
|---|---|
| Subjects: | R Medicine > RD Surgery |
| Divisions: | Africana |
| Depositing User: | Geoffrey Obatsa |
| Date Deposited: | 01 Aug 2016 05:50 |
| Last Modified: | 19 Jul 2017 11:30 |
| URI: | http://thesisbank.jhia.ac.ke/id/eprint/866 |
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