Treatment of Hydrocephalus in Germany

Hydrocephalus is the accumulation of excess cerebrospinal fluid in the brain with increased intracranial pressure. The leading cause is an impaired outflow of the cerebrospinal fluid. It can develop due to many different diseases: tumors, brain malformations, hemorrhages, inflammatory processes, etc. Hydrocephalus treatment in Germany is successfully provided with open and endoscopic surgical procedures. Most patients achieve a good long-term outcome, and the risk of necessity of revision surgery in the future is minimal.

Content

1. Extracranial ventricular shunting
2. Endoscopic third ventriculostomy
3. Tumor resection

Extracranial ventricular shunting

When performing extracranial cerebrospinal fluid shunting, doctors divert CSF outside the ventricular system, usually into the abdominal cavity, by placing a catheter with a valve mechanism. The main advantage of the method is its versatility. It can be used for any form of hydrocephalus.

Nonetheless, there is also a drawback – a high risk of complications. The most common complication is shunt dysfunction, which requires a revision surgery. It develops in every third patient within 2 years of follow-up monitoring. The formation of pseudocysts in the abdominal cavity, ascites (fluid accumulation), and perforation of the internal organs are also possible.

Thanks to the improved design of valvular shunts and the improvement of surgical techniques, the frequency of revision surgery in the best clinics in Germany has decreased by 2,5 times. The mortality of patients treated for hydrocephalus in Germany is less than 0,1%. In addition, more and more German doctors prefer to perform another operation – ventriculostomy, which is considered more sparing and safe.

Endoscopic third ventriculostomy

The ETV (endoscopic third ventriculostomy) operation is gradually replacing shunting surgery. This is a minimally invasive intervention that is performed through short incisions. The essence of this treatment method is endoscopic perforation (formation of holes) of the bottom of the third ventricle, which allows cerebrospinal fluid to enter the subarachnoid space bypassing the blocked area.

The main advantage is that there is no need for the implantation of a foreign body to provide the normal circulation of CSF. But there are limitations: this type of treatment is used only for obstructive hydrocephalus.

It is essential to perform surgery in a specialized clinic to ensure good long-term results. Over time, stoma failure may develop due to blood clots, adhesions, tumor growth, and other causes. On average, in the world, the long-term effectiveness of the operation is 70%, but in the best clinics in Germany it reaches 90%.

Like other interventions on the central nervous system, the ETV operation is not completely safe. Severe complications are possible, the main of which is trauma to the basilar artery. Mortality during this operation is about 4%. But in the best clinics in Germany, it is several times lower due to the greater qualification of neurosurgeons and the use of high-quality equipment. In the specialized centers, mortality rates for endoscopic treatment of hydrocephalus are less than 1%. Rehabilitation is easier and faster than after open shunting surgery.

Tumor resection

Hydrocephalus often has a tumor origin. In such a case, it is necessary, first of all, to remove the tumor. Doctors in Germany perform safe microsurgical interventions, which allow them to remove even hard-to-reach large neoplasms.

As a rule, removing the benign tumor is sufficient to normalize the CSF movement completely. No additional procedures are required to eliminate hydrocephalus.

At the same time, malignant tumors often penetrate deep into the brain, changing its tissues, and they cannot always be completely removed. As a result, the block of CSF pathways can not permanently be eliminated, and if possible, hydrocephalus may develop due to cerebral edema and hematoma. Such patients additionally require an ETV or shunting. Sometimes ETV is performed prior to tumor removal surgery to prevent postoperative hydrocephalus.

In addition, in Germany, additional manipulations can be performed during surgical tumor removal to prevent hydrocephalus and eliminate the need for revision interventions. These can be:

• Stent implantation into the CSF spaces of the brain.
• Intraoperative shunting.
• Microsurgical fenestration (creation of holes) of the fundus of the third ventricle.

To undergo hydrocephalus diagnostics and treatment, you can go to one of the clinics in Germany. The treatment in clinics in Germany is sparing, safe and reliable. You are unlikely to need a revision surgery even after many years. On the Booking Health website, you can find out what is the price for treatment in different clinics, compare prices and book a medical care program at the best price. The cost of treatment for you will not increase, as you will receive insurance that will cover additional expenses. The Booking Health specialists will help you select the most suitable clinic and take care of the arrangement of your trip.

Authors: 

The article was edited by medical experts, board certified doctors Dr. Vadim Zhiliuk and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

WHO - World Health Organization

Medscape

Sience Direct