Hidrocefalia Del Prematuro
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Transcript of Hidrocefalia Del Prematuro
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TRATAMIENTO DEL PREMATURO CON HIDROCEFALIA
DR ANTONIO GARCIA MENDEZNEUROCIRUGIA PEDIATRICA
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INSTITUTO MEXICANO DEL SEGURO SOCIAL
SERVICIO DE NEUROCIRUGIA PEDIATRICAHOSPITAL GENERAL CMN LA RAZA
DR JOSE MANUEL MUÑOZ TAGLEDR JOSE DE LA CRUZ MORALESDR JUAN A. MUÑOZ BELLIZZIADR ARMANDO GUERRERO GUERRERODR JUSTINO HERNANDEZ JIMENEZDR ISRAEL DEL ANGELDR ENRIQUE MELENDEZ
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TRATAMIENTO DEL PREMATURO CON HIDROCEFALIA
¿QUE HACER?
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EVALUACION PREOPERATORIA
•EDAD GESTACIONAL•PERIMETRO CEFALICO•FONTANELA ANTERIOR•GRADO DE PAPILE•PESO: MENOR DE 2500 GRS.•TOMOGRAFIA DE CRANEO SIMPLE
Pediatric Neurosurgery 2003
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TRATAMIENTO MEDICO
Pediatric Neurosurgery 2003
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TRATAMIENTO QUIRURGICO
PUNCION INTERMITENTE FONTANELAR VENTRICULOSTOMIA PUNCION LUMBAR COLOCACION DE RESERVORIO SUBGALEAL FIBRINOLISIS INTRAVENTRICULAR DRENAJE NEUROENDOSCOPICO DERIVACION VENTRICULO PERITONEAL
Pediatric Neurosurgery 2003
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PUNCION TRANSFONTANELAR
VENTAJASHIDROCEFALIAINESTABILIDAD HEMODINAMICA DEL PREMATUROURGENCIA POR HIPERTENSION ENDOCRANEAL
DESVENTAJASRIESGO DE INFECCIONRIESGO DE SANGRADO DEL SSSPUNCION FRECUENTE DE LA CORTEZA CEREBRAL
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VENTRICULOSTOMIA
RIESGO DE INFECCION 6%MORTALIDAD 27%SOBREDRENAJEVACIAMIENTO INCIDENTAL
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RESERVORIO DE OMAYA SUBGALEAL
•PUNCION CADA 48 HRS•INFECCION 8%•FISTULA DE LCR 12 %•OBSTRUCCION
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FIBRINOLISIS INTRAVENTRICULAR
Randomized Clinical Trial of Prevention of Hydrocephalus After Intraventricular Hemorrhage in Preterm Infants: Brain-Washing Versus Tapping Fluid Andrew Whitelaw, David Evans, Michael Carter, Marianne Thoresen, Jolanta Wroblewska, Marek Mandera, Janusz Swietlinski, Judith Simpson, Constantinos Hajivassiliou, Linda P. Hunt and Ian Pople Pediatrics 2007;119;e1071-e1078; originally published online Apr 2, 2007; DOI: 10.1542/peds.2006-2841
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DRENAJE DE HEMATOMA POR NEUROENDOSCOPIA
•INFECCION•HIDROCEFALIA•TERCER VENTRICULOS.•FISTULA DE LCR•SANGRADO
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TRATAMIENTO DEL PREMATURO CON HIDROCEFALIA
¿QUÉ ESTAMOS HACIENDO?
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TRATAMIENTO DEL PREMATURO CON HIDROCEFALIA
DERIVACION VENTRICULOSUBGALEAL
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TRATAMIENTO DEL PREMATURO CON HIDROCEFALIA
CASOS CLINICOS
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DERIVACION VENTRICULOSUBGALEAL EN PREMATUROS CON HIDROCEFALIA
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TRAMIENTO DEL PREMATURO CON HIDROCEFALIA
MASCULINO DE 28 SEMANAS HIDROCEFALIA SECUNDARIA A HEMORRAGIA GRADO IV DE PAPILE. PESO 1250 GRS.CIRUGIA A LAS 36 SEMANAS
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PREPARACION
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POSICION E INCISION
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DISECCION SUBGALEAL
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VERIFICAMOS FUNCIONAMIENTO
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CASO CLINICO
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TRATAMIENTO DEL PREMATURO CON HIDROCEFALIA
MASCULINO DE 32 SEMANAS DE GESTACION,HIDROCEFALIA SECUNDARIA A HEMORRAGIA GRADO IV. PESO 1800 GRS.CIRUGIA 36 EMANA DE GETACION
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1 (32)-36 mac. pectus.exc. IV DVP 1800 gr 2650
2 (26)-36 mac. diplasia pulmonar III DVP 1200 gr 2555
3 (26)-36 fem diplasia pulmonar IV DVP 1350gr 2500
4 (28)-34 masc. sepsis IV DVP 1150 gr 2500
5 (26)-34 masc.sepsis, displasia broncopul. IV Falleció 1260gr 1900
6 (31)-32 masc. no IV DVP 1325 gr 2100
7 (30)-34 fem diplasia pulmonar IV DVP 1230 gr 2800
8 (28)-34 masc. neumonia IV DVS 1350gr 1970
9 (31)-36 mac.retinopatia del prem. IV DVS 1350 gr 2300
10 (27)-34 ma dip.pulmonar,sepsis,ente.nec. IV Falleció 1200 gr 2500
11 (28)-34 masc.retinopatia del prem. IV DVP 1250 gr 2350
12 (32)-36 fem anemia IV DVP 1680gr 2230
13 (28)-36 femretinopatia del prem. IV DVP 1358 gr 2500
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mac.69%
fem31%
RELACION H/M
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1 2 3 4 5 6 7 8 9 10 11 12 13
32
26 2628
26
31 3028
31
27 28
32
28
36
36 36 3434
32 3434
36
34 34
36
36
EDAD NACI/CIRUGIASeries1 Series2
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1800 gr 1200 gr 1350gr 1150 gr 1260gr 1325 gr 1230 gr 1350gr 1350 gr 1200 gr 1250 gr 1680gr 1358 gr
1 2 3 4 5 6 7 8 9 10 11 12 13
0
500
1000
1500
2000
2500
3000
Series1
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DVP DV fallecio0
1
2
3
4
5
6
7
8
9
10 DERIVACION DEFINITVA
Títu
lo d
el e
je
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CONCLUSIONES
ALTERNATIVA SEGURA EN HIV DEL PREMATURO CON HIDROCEFALIACONTROL DEL DRENAJE VENTRICULARREDUCCION DEL TAMAÑO VENTRICULARDIMINUCION DEL RIESGO DE INFECCIONVENTRICULAR
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FRAGIL MANEJESE CON CUIDADO
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DERIVACION VENTRICULOSUBGALEAL EN PREMATUROS CON HIDROCEFALIA
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