Endoscopic electrocoagulation of the choroid plexus in the lateral ventricle of hydrocephalus

Endoscopic electrocoagulation is used to burn bilateral ventricular choroid plexus, which is the traditional method for treating hydrocephalus. This method achieves the goal of relieving hydrocephalus by reducing the secretion of cerebrospinal fluid in the choroid plexus. Pople et al (1995) reported 36 cases of long-term follow-up after surgery, symptomatic stability accounted for 64%. Treating diseases: hydrocephalus Indication 1. Traffic hydrocephalus, symptoms slowly develop. 2. Ineffective in the ventriculo-peritoneal (VP) shunt. Contraindications Intraventricular infection. Other methods are used for non-communicating hydrocephalus. Preoperative preparation 1. There must be a correct positioning diagnosis before surgery. In recent years, due to advances in imaging inspection technology, clinical applications such as CT, MRI, and DSA have become increasingly widespread. The relationship between the location of the lesion and the surrounding structure should be analyzed before surgery in order to select the appropriate surgical approach, to obtain the best exposure, avoid the important structure of the skull as much as possible, increase the safety of the operation and strive for good Effect. 2. Skin preparation, wash the head with soap and water 1 day before the operation, shave the hair on the morning of the operation. You can also shave your head on the eve of surgery. 3. Fasting the morning of surgery. It can be enema in the evening before surgery, but when the intracranial pressure is increased, the enema should be removed to avoid sudden deterioration of the condition. 4. Give phenobarbital 0.1g orally before surgery to ensure a quiet rest. One hour before the operation, 0.1 g of phenobarbital, 0.4 mg of atropine or 0.3 mg of scopolamine were intramuscularly injected. 5. Prepare the endoscopic surgery equipment. Surgical procedure Incision Usually, it is 1cm in front of the right coronary suture and 3cm in the middle of the midline. The longitudinal incision is 253cm, and the diameter of the skull is 1cm. 2. Insert the endoscope The dura mater is cut in a "ten" shape, and an endoscope with a diameter of 4 to 6 mm is placed in the lateral ventricle to identify anatomical landmarks such as the venous vein and the septum. 3. Electrocoagulation choroid plexus Through the endoscopic working circuit, the surface of the choroid plexus can be burned by electrocoagulation probe or laser, and the range can be from the interventricular space to the choroid plexus of the triangle; the endoscope enters the contralateral ventricle through the transparent partition of the fenestration, Its choroid plexus undergoes coagulation. 4. After confirming that there is no bleeding, pull out the endoscope and insert an external drainage tube into the right ventricle. complication 1. The earliest and most serious complication after surgery is intracranial hemorrhage. A common cause is that hemostasis is not complete during surgery. Patients with concurrent intracranial hemorrhage, or delayed waking after surgery, or apathy, lethargy, headache, vomiting, seizures or re-coma after waking. Therefore, there is no special reason after surgery for a long time, not awake or consciousness is gradually worsened, and signs of increased intracranial pressure such as slow pulse, elevated blood pressure, or new neurological symptoms should be paid attention to, should be highly alert to the skull The possibility of internal bleeding. CT examination should be performed in time when conditions are met, and the hematoma should be removed immediately after diagnosis. The earlier the surgery, the better the consequences. 2. Extensive choroid plexus coagulation can cause high fever and requires symptomatic treatment.