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Is surgery required for hydrocephalus with subdural haematoma?

Q: My mother, 69 years old, is an insulin-dependent diabetic for about 18-19 years and also hypertensive. Recently she was diagnosed with deep vein thrombosis (DVT) in both her legs. She did not undergo any surgery for this and was on anticoagulants. She had a subdural haematoma last month and slipped into coma. The doctors performed a surgery to stop the bleeding. She has developed hydrocephalus and is still semi-comatose. The doctors had placed a theco-peritoneal shunt which probably is not functioning. They have now drilled a tap on the right ventricle and the fluid flow is quite rapid. They also feel a permanent shunt is necessary. Will my mother be able to live normally? All her vital signs have been quite stable throughout this period. Will the shunt improve consciousness levels?

A:She would have to be off anticoagulants till the subdural settles down which may take months. Meanwhile she could wear stockings especially customised for the treatment of DVT. The problem with her hydrocephalus is that as she has a subdural she would be especially prone to over drainage with a shunt which would then perpetuate her subdural. Also, these hydrocephalus tends to be low pressure systems and we again have a clash in the requirements of draining the ventricles enough but at the same time not overdoing it. This is a controversial subject and various neurosurgeons would have differing opinions. Personally, I would go in for a standard phoenix diamond shunt which comes in the group of variable resistance flow regulated devices. In the end the shunt should help her. This should not be delayed.

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