Management Of Congenital Hydrocephalus In The Neurosurgery Unit In Assiut University:

Hani Mostafa Mohamed Hammam

SIIf1ARY This thesis Comprizes 2 parts. A subsidiary study on the cases of intra uterinehydrocephalus in the deliveries of one l”earin the obstetricdepartment.The basic study on 31 operated cases of Congenitalhydrocephalus by ventriculo-atrial shunt.this study emphasizeda complete History-clinical examination, follow upof Head circumference on special charts, x-ray skull ,Qperative procedure , post operative complications, andmortality,. These 31 cases were selected from 99 infantspresented to the out patient clinic of neurosurgery byhead enlargement , all the cases aged less than 2 years ,clinically suspected Cases of post~eningetic and posttumoral hydrocephalus were excluded.The results of the studies showed ~~e following4 cases of intrauterine hydrocephalull in 1140 deliveries(1 male, 3 females).The average age of the operated cases is 5 months.Sex-ratio of the presented cases male/female-74/25 comparedto 23/8 in the operated group.45 of the mothers were primiparas.77 of maternal ages 11e in the age g]~UP 20-30 years.The commonest presenting complaint is progressive headenlargemeBJl.Late age presentation.The head circumference varied from 40·-59CIII.• The thickness of·cerebral mantle is l.nversely proportionalto the head circumference.• Craniofacial disproportion , sun set appearance, ”tensewidely openedanterior fontanell and dilated scalpveins are a constant physical signs.Onradiological examination we found thin skull bones,opened anterior fontanell , supra tentoJ~ial sutural separationcranio fascial disproportion are a Clonstantradiologicalsigns. C.S.F. pressure is high in 29 C~lsesand low in 2cases, pudenz valve system is applied :I.nall cases mediumpressure in 29 cases low pressure in 2 Clases. The rightinternal jugular vein is cathetrized in (24 cases) , thecammonfacial vein in 7 cases. Cardiac irregularitiesare noticed in most of the cases during instillation ofthe atrial catheter. Death in 3 cases It total mortality9.6) due to ventriculitis in 2 cases imd subduralhaematanain 1 cases. Valve obstruction in 3 cases.Revision revealed obstruction of the vElntricular catheterby brain matter in the 3 cases. The aVElrageduration offollow up after operation is 8 months.