Hydrocephalus in an abandoned child

[Dipen]

This 3 yrs female child with Hydrocephalus was abandoned in Kanti Children's Hospital at 19 days of age and since then she's there in that hospital.

Her head size has been gradually increasing approximately 1cm/month, but there’s no recent increase in size for the past few months. Her present OFC is >76 cm. She was seen by Neurosurgeon and Pediatric Surgeon and planned for shunting operation, but was cancelled due to poor outcome of the surgery.

• CT Scan Image 1
• CT Scan Image 2

At present she’s been looked after by KCH, Kathmandu and volunteers from SAV. We staff from HHC too had an opportunity to have a look at the case, and trying to help in all the possible way.

If you or someone who you know is interested to help this orphan please contact xenoMED for further details. I will update regularly any further information regarding this child.

[Paranoid]

her names shristi , i think. and her parents had collected the money for the operation but they left her in hospital and ran with the money. Though she doesnt have biological parents she has many parents there who really care.

[Sarensa]

So shameful to hear that her parents ran with the money that was collected for her treatment. Some people do such things that it becomes difficult to collect money for the poor b'cozthey think that everyone will do the same. I pray to god for her good health and Depen dai If I can do anything than plz do tell me.

[CSF]

i'm very sad to learn that a 19 days old baby is left abandoned in the kanti child hospital and and ever since (3 yrs) she is without her parents that too developed hydrocephalus and it made me happy that there are many people who came forward to help her.

But what can be done to her as she was rejected from the OT, she is so cute.

Friends if anyone of you know who are willing to help the child like this people then please inform the kanti child hospital.

Thanks for all the help.

[justin]

very sad to hear this news
Now wht kinda treatment will be there for this cute child??

[Oak]

Originally Posted by justin

very sad to hear this news
Now wht kinda treatment will be there for this cute child??

Medical Care:

• Medical treatment is used to delay surgical intervention. It may be tried in premature infants with posthemorrhagic hydrocephalus (in the absence of acute hydrocephalus). Normal CSF absorption may resume spontaneously during this interim period.
• Medical treatment is not effective in long-term treatment of chronic hydrocephalus. It may induce metabolic consequences and thus should be used only as a temporizing measure.
• Medications affect CSF dynamics by the following mechanisms:
  • Decreasing CSF secretion by the choroid plexus - Acetazolamide and furosemide
  • Increasing CSF reabsorption - Isosorbide (effectiveness is questionable)

Surgical Care:

• Surgical treatment is the preferred therapeutic option.
• Repeat LPs can be performed for cases of hydrocephalus after intraventricular hemorrhage, since this condition can resolve spontaneously. If reabsorption does not resume when the protein content of CSF is less than 100 mg/dL, spontaneous resorption is unlikely to occur. LPs can be performed only in cases of communicating hydrocephalus.
• Alternatives to shunting include the following:
  • Choroid plexectomy or choroid plexus coagulation may be effective.
  • Opening of a stenosed aqueduct has a higher morbidity rate and a lower success rate than shunting, except in the case of tumors. However, lately cerebral aqueductoplasty has gained popularity as an effective treatment for membranous and short-segment stenoses of the sylvian aqueduct. It can be performed through a coronal approach or endoscopically through suboccipital foramen magnum trans-fourth ventricle approach.
  • In these cases, tumor removal cures the hydrocephalus in 80%.
  • Endoscopic fenestration of the floor of the third ventricle establishes an alternative route for CSF toward the subarachnoid space. It is contraindicated in communicating hydrocephalus.

• Shunts eventually are performed in the majority of patients. Only about 25% of patients with hydrocephalus are treated successfully without shunt placement. The principle of shunting is to establish a communication between the CSF (ventricular or lumbar) and a drainage cavity (peritoneum, right atrium, pleura). Remember that shunts are not perfect and that all alternatives to shunting should be considered first.
• • A ventriculoperitoneal (VP) shunt is used most commonly. The lateral ventricle is the usual proximal location. The advantage of this shunt is that the need to lengthen the catheter with growth may be obviated by using a long peritoneal catheter.
  • A ventriculoatrial (VA) shunt also is called a "vascular shunt." It shunts the cerebral ventricles through the jugular vein and superior vena cava into the right cardiac atrium. It is used when the patient has abdominal abnormalities (eg, peritonitis, morbid obesity, or after extensive abdominal surgery). This shunt requires repeated lengthening in a growing child.
  • A lumboperitoneal shunt is used only for communicating hydrocephalus, CSF fistula, or pseudotumor cerebri.
  • A Torkildsen shunt is used rarely. It shunts the ventricle to cisternal space and is effective only in acquired obstructive hydrocephalus.
  • A ventriculopleural shunt is considered second line. It is used if other shunt types are contraindicated.

• Rapid-onset hydrocephalus with increased ICP is an emergency. The following can be done, depending on each specific case:
  • Ventricular tap in infants
  • Open ventricular drainage in children and adult
  • LP in posthemorrhagic and postmeningitic hydrocephalus
  • VP or VA shunt

Consultations:

• Neurosurgery
• Neurology
• Neurorehabilitation
• Ophthalmology

Diet: Regular, as tolerated Activity: Most surgeons agree that, with the use of antisiphon devices, no special positioning is required after shunting. However, some surgeons used to leave patients in whom a standard shunt had been placed in a recumbent position for 1-2 days after surgery to minimize risk of subdural hematoma. In treatment of NPH, gradual postoperative mobilization is recommended.

http://www.emedicine.com/neuro/topic161.htm

[Oak]

Hydrocephalus Association
http://www.hydroassoc.org




Paediatric Neurosurgery
http://www.cumc.columbia.edu/dept/nsg/PNS/Hydrocephalus.html




Hydrocephalus Cener
http://www.oreilly.com/medical/hydrocephalus/

[Oak]

Originally Posted by CSF

Friends if anyone of you know who are willing to help the child like this people then please inform the kanti child hospital.

Thanks for all the help.

I have emailed this page to Hydrocephalus Association and asked them to contact xenoMED.

Lets hope for the best.

[bharat]

Originally Posted by Oak

I have emailed this page to Hydrocephalus Association and asked them to contact xenoMED.

Lets hope for the best.

great work OAK bro. and thaks for the massage related to Hydocephalus
well our lab. also has such kind of baby and this time i saw the living one well i am also greatfull to Dipen bro.

[Dipen]

Thanxz friends for the effort u have been showing. I will post the CT-scan of this child too, so that it becomes more easy for case discussion and expert opinion. Lets pray something could be done.