Hydrocephalus in children hydrocephalus in children it is a disease of cranial enlargement and brain dysfunction caused by increased intracranial pressure due to impaired cerebrospinal fluid circulation. It is caused by brain malformation, infection, hemorrhage, tumor and many other aspects. The main manifestation is “large head”, often children are born with a head circumference of 33-35 cm, the first six months of growth is faster, 8 cm, (about 42-45 cm), the second half of the growth of 3 cm (43-47 cm), if the child’s head circumference exceeds the above range and rapid growth, we should pay attention to the possibility of hydrocephalus. Causes of hydrocephalus onset in children Hydrocephalus in children can be caused by the following three factors: excessive production of cerebrospinal fluid; obstruction of the pathways of cerebrospinal fluid and impaired absorption of cerebrospinal fluid. The cause of congenital hydrocephalus is currently thought to be obstruction of the cerebrospinal fluid circulation pathway. The causes of obstruction can be divided into two categories: congenital developmental abnormalities and nondevelopmental etiologies. The treatment of pediatric hydrocephalus is introduced 1, drug therapy (1) inhibit cerebrospinal fluid secretion drugs: such as acetazolamide (acetazolamide), is through the inhibition of choroid plexus epithelial cells Na + – K + – ATPase, reduce the secretion of cerebrospinal fluid. (2) Diuretics: furosemide. The above methods should be preferred for those with mild hydrocephalus within 2 weeks of age, and can be controlled in about 50% of patients. (3) Osmotic diuretics: sorbitol and mannitol. The former is easily absorbed in the intestine and has no irritation, with a half-life of 8h, 1~2g/(kg?d). The drug is mostly used for moderate hydrocephalus as a short-term treatment for deferred surgery. In addition, in addition to drug therapy, it is effective for acute hydrocephalus produced by ventricular hemorrhage or tuberculosis and septic infection, which can be combined with repeated lumbar punctures to drain cerebrospinal fluid. Anyone attempting to control hydrocephalus with medications should be closely observed for neurological status and continuous examination of ventricular size changes. Drug therapy is generally indicated only for mild hydrocephalus. Although some infants or children do not have hydrocephalus symptoms, patients can have progressive ventricular enlargement, so that some children, although compensated, will eventually affect the neurological development of the child. Drug therapy is generally used to temporarily control the development of hydrocephalus before shunt surgery. 2.Ventricular shunt Torkldsen (1939) first reported the use of rubber tubes to do lateral ventricular and occipital pool shunt, which is mainly applied to ventricular midline tumor and aqueduct occlusion hydrocephalus. Later, in patients with hypoplastic midbrain aqueducts, dilation was performed by inserting a rubber catheter from the fourth ventricle upward to the narrowed midbrain aqueduct, which resulted in high operative mortality due to surgical damage to the gray matter surrounding the aqueduct. Internal shunt is a shunt between the lateral ventricle and the sagittal sinus. This method is theoretically consistent with the physiology of cerebrospinal fluid circulation, but is not used much in practice. (1) Ventricular extracranial shunt: The principle of this surgical method is to drain the cerebrospinal fluid into a cavity where the body can absorb cerebrospinal fluid. Currently, ventriculo-abdominal shunts, ventriculo-atrial shunts and ventriculo-subarachnoid shunts are commonly used to treat hydrocephalus. Because ventriculo-atrial shunts require the shunt tube to be permanently placed in the heart, interfering with the physiological environment of the heart and causing the risk of cardiac arrest and some other cardiovascular complications, they are currently only used for patients who cannot undergo ventriculo-abdominal shunts. Spinal subarachnoid-ventricular shunts are only used in patients with traffic hydrocephalus. Ventriculoperitoneal shunts are still the preferred method. In addition, previous literature reported that ventricular-thoracic shunts, ventricular shunts with ureter, bladder, thoracic duct, stomach, intestine, mastoid and milk duct shunts have no clinical application value and have been abandoned. (2) The ventricular shunt device consists of three parts: ventricular canal, unidirectional valve, and distal canal. However, the spinal subarachnoid-peritoneal shunt is the subarachnoid tube. In recent years, some new shunts are equipped with additional devices such as anti-siphon, reservoir chamber and automatic opening and closing flap. (3) Surgical method: The patient lies supine with the head turned to the left, the back is elevated, the neck is exposed, the head is incised, 4-5 cm from the right auricle to 4-5 cm posteriorly, a 2-cm long incision is made in the flat part of the skull, the retractor is pulled apart, the hole is drilled, and the ventricular tube is inserted from the occipital angle to reach the frontal angle about 10-12 cm long. The reason is that the frontal horn is wide without the choroid plexus and the pressure gradient of the contralateral cerebrospinal fluid flowing through the Monor foramen to the shunt tube is small. The reservoir or valve is placed under the scalp for fixation, and the distal tube is placed from the subcutaneous tissue of the neck and chest to the abdominal wall. The abdominal incision can be made in the mid-abdomen or lower abdomen 2.5 to 3.0 cm next to the midline or next to the rectus abdominis muscle. The distal lateral tube is placed into the abdominal cavity. Alternatively, the abdominal wall is punctured with a trocar needle and the shunt tube is inserted into the abdominal cavity through the cuff tube. The upper end of the abdominal tube is passed through the subcutaneous tissue next to the sternum to reach the neck, where it is connected to the valve tube.