Guideline for the management of long tunnelled external ventricular drains in chronic hydrocephalus
This article reports on the journey of a child with an inoperable hypothalamic-origin pilocytic astrocytoma causing hydrocephalus, which was refractory to treatment with shunts, and required a new approach. With multidisciplinary support, excellent nursing care and parental education, the child's hydrocephalus was managed long term in the community with bilateral long-tunnelled external ventricular drains (LTEVDs). This article describes the patient's journey and highlights the treatment protocols that were created to achieve this feat. Despite the difficulties in initially setting up these protocols, they proved successful and thus the team managing the patient proposed that LTEVDs are a viable treatment option for children with hydrocephalus in the context of inoperable tumours to help maximise quality of life.
Inside the brain resides a system of reservoirs (ventricles) that house cerebrospinal fluid (CSF). The purpose of CSF is to provide the brain with buoyancy, to act as a protective ‘shock absorber’ and to aid in the distribution and removal of products to cells across the brain. CSF is produced chiefly in the lateral ventricles and flows through the ventricular system and subarachnoid spaces of the spine before being reabsorbed (mainly via the arachnoid granulations of the superior sagittal sinus system) (Figure 1). Hydrocephalus is a condition characterised by excess CSF fluid build-up within the brain, which can be due either to excess production of CSF, obstruction in the usual CSF pathways or blockage of the usual mechanisms that reabsorb CSF. The condition remains difficult to treat, with the major strategy being diversion of CSF away from the brain to relieve excess pressure on the organ. This article presents the case of a child with an inoperable brain tumour and hydrocephalus who was treated in an unusual manner using long-tunnelled external ventricular drains (LTEVDs).
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