Taming The SRU
Taming The SRU - March 14, 2023 - By Cody Stothers
INTRODUCTION
Hydrocephalus is an accumulation of cerebrospinal fluid (CSF) in the cerebral ventricular system secondary to a mismatch between CSF production and resorption. Excessive production of CSF is rare and occurs with choroid plexus papillomas or other tumors. Impaired drainage or resorption of CSF is a far more common cause of hydrocephalus and can occur due to congenital malformations, tumors, trauma, or infection. Rapid development of hydrocephalus in the acute setting presents with signs and symptoms of increased intracranial pressure and represents a surgical emergency because of the risk of herniation syndromes.
TREATMENT
If a patient is herniating in front of your eyes – hypertensive, bradycardic, altered, and not protecting their airway – secure the ABCs, provide hypertonic fluids (3% normal saline, mannitol), hyperventilate the patient, elevate the head of the bed and call neurosurgery. Definitive management in these, and less acute cases, is often the placement of a ventriculoperitoneal (VP) shunt.
More on this below as we work through a few cases