1/22/2009

Pediatric Surgery Care

ระบบประสาท

By
Bby Susheewa Wichaikull

• Hydrocephalus ( อุทกเศียร)
• Meaningocele
• Spina Bifida

Hydrocephalus พยาธิสรี รภาพ

Hydrocephalus is commonly known as Choroid Plexus ใน Ventricle(Lateral)
'water on the brain'. A watery fluid , Foramen of Monro
known as cerebro-spinal fluid or CSF, Third Ventricle,Fourth Ventricle
Foramen of Luschka
is produced constantly inside each Foramen of Magendie
of the four spaces or ventricles inside Cistena Magna
the brain. Arachnoid ไหล Flow ไปรอบสมองและไขสันห

Arachnoid Villi ดูดซึมเข้ากระแสเลือด

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What causes Hydrocephalus?

The condition is caused by the inabilit
of CSF to drain into the bloodstream.
1. The CSF abnormally flows through narrow
pathways from one ventricle to the next.
Such as Tumor obstruction , Dandy Walker Cy
brain heamorrhage ,and so on.
2. Communicate Hydrocephalus
The CSF is not absorbed into the bloodstream
and recirculates well.Such as septicemia like
Meaningitis,from mother disease , Genetic and

Sign and Symtom

Acute Hydrocephalus Increasing
Intracraneal Pressure
• fatigue
• general malaise
•visuo perceptual problems
•visuo-perceptual
•behavioural changes
•Setting sun sign
•Macewen’s sign
Cronic Hydrocephalus
How is Hydrocephalus Treated?
Some forms of hydrocephalus require
no specific treatment. Other forms are
temporary and do not require long-term
treatment However,
treatment. However most forms do requ
treatment, and this is usually surgical.
Drugs have been used for many years but
may have unpleasant side effects and
are not often successful.

The usual treatment is to insert

What is a Shunt?
a shunting device.
A shunt is simply a device which
Shunting controls the pressure by
diverts the accumulated CSF from
draining excess CSF, so preventing
the obstructed pathways and
th condition
the c nditi n b
becoming
c min worse.
rs
returns it to the bloodstream.
An alternative treatment may be
third ventriculostomy. This treatment
if successful, avoids the need for a sh

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It is inserted surgically so that the

upper end is in a ventricle of the brain
and the lower end leads either,
• into the heart (ventriculo-atrial)
• into the abdomen (ventriculo-
peritoneal).
• into the outer lining of the lungs
(ventriculo-pleural shunt

Treatment What are the effects of hydrocephalus?

There can be learning difficulties associated

•Ventriculo-atrial shunt with hydrocephalus such as problems with
concentration, reasoning and short-term
• Ventriculo-peritoneal y Hydrocephalus
memory. y p can also result in
shunt
h subtle effects: giving problems with
co-ordination, motivation and organisational
•Ventriculo-plural shunt
skills. Physical effects such as visual problems,
• Ventriculo-atrial shunt or early puberty in children, may also occur.

•SB with Medication

Nursing Care Spina Bifida

• Observe to precaution sign vomiting, headach,
dizziness, photophobia (sensitivity to light)
and other visual disturbances, drowsiness and fits
•Precaution In shunt infections
•Observer Nuro sign , Vital sign
• Semi Fowler’s position
• To measure abdomen and Head curcumcission
Spina Bifida is a fault in the spinal column
in which one or more vertebrae
(the bones which form the backbone)
faill to form properly, leaving
fa leav ng a gap or spl
split,
t,
causing damage to the central
nervous system.

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Spina Bifida
The central nervous system and spine
develop between the 14th and 28th day
after conception. Spina bifida occurs
when there is a failure of development o
the boney canal which surrounds the bra
and spinal cord.
Spina Bifida Cystica (cyst-like)
The visible signs are a sac or cyst,
rather like a large blister on the back,
covered by a thin layer of skin.
There are two forms:
PIDEMIOLOGY:
• incidence: 1-2/1000 live births
(of spina bifida cystica)
•age of onset:less than 26 days
gestational age
g g
•risk factors:
1. Genetic
2. Nutritional and Environmental
Factors
3. Drugs
1/22/2009
Types of Spina Bifida
There are three main types of spina bifid
Spina Bifida Occulta (hidden)
There is a slight deficiency in
the formation of (usually)
one of the vertebrae.
It may have visible signs of
a dimple or small hair growth
on the back
Meningocele
Meninggomyelocele
and eningoencephalocele
A neural tube defect affecting g
the spine resulting in the herniation
of the meninges through a vertebral
defect in the lumbar region.
TYPES:
1. Posterior Meningocele
•most common type of
meningocele
•hernia contains no neural tissue
p j
•projects externally
y through
g a
defect in the posterior aspect of
the vertebral arch
•usually covered by a thick -> thin
layer of skin or membrane
•may or may not leak CSF
•usually not associated with
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2. Anterior Meningocele Treatment

•uncommon type of meningocele
•hernia contains no neural tissue
•projects internally through a defect
in the anterior aspect of the
vertebrae
t b int
into th
the p
pelvis
l is
•complications include: constipation
and/or bladder dysfunction females
may have associated anomalies of
the GU tract such as retrovaginal
fistula ,vaginal septa .

A defect which also includes a small, moist

sac (cyst) protruding through the spinal
defect, containing a portion of the spinal
cord membrane (meninges), spinal fluid, and a
portion of spinal cord and nerves is called a
meningocele, myelomeningocele, or
meningomyelocele.
*Surgical treatment is needed to repair the
defect and is usually done within 12 to 24
hours after birth to prevent infection,
swelling, and further damage.

The long-term result depends on the condition
of the spinal cord and nerves. Outcomes range
from normal development to paralysis
(paraplegia). Infants may require about 2 weeks
in the hospital after surgery.
Nursing Care
• Decreasing risk factor in
pregnancy such as sepsis and
folic acid deficiency
• Prevention rupture of cyst
• Crede’s maneuver after void
•rectal exercise
• prevention pressure sore