Brain Shunting in Israel

Professor Itzhak Fried

Head of the Functional Neurosurgery Department

There are many factors that lead to impaired circulation of cerebrospinal fluid (CSF), the main ones include:

• traumatic brain injuries,
• brain tumours;
• subarachnoid hemorrhages;
• previous neuroinfections, such as adhesive arachnoiditis;
• chronic circulatory insufficiency;
• prematurity;
• birth injuries, etc.

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high-precision diagnostic program

All of the above conditions lead to pathological processes that disrupt the balance between the production and resorption of cerebrospinal fluid, resulting in increased intracranial pressure and hydrocephalus.

The Israeli Top Ichilov Clinic diagnoses hydrocephalus using several effective methods:

1. clinical examination,
2. computed tomography or magnetic resonance imaging (CT and MRI) of the brain,
3. lumbar puncture,
4. fundus examination.

Upon establishing a definitive diagnosis, the clinic performs surgical treatment for hydrocephalus — cerebrospinal fluid shunting — which restores the physiological flow of cerebrospinal fluid and alleviates symptoms of increased CSF pressure. The essence of shunting is that excess cerebrospinal fluid is removed from the brain ventricles to the body's cavities through a system of valves and tubes.

Neurosurgeons at Top Ichilov Medical Center perform many different types of shunting indicated in various clinical cases.

Ventriculoatrial shunting — connecting the lateral ventricles of the brain with the right atrium and superior vena cava.

Ventriculoperitoneal shunting — connecting the lateral ventricles with the abdominal cavity.

Ventriculocisternostomy — connecting the posterior horn of the lateral ventricle with the cisterna magna.

Lumboperitoneal shunting — connecting the lumbar sac with the abdominal cavity.

Subdural-peritoneal and cyst-peritoneal shunting — connecting subdural hygromas and arachnoid cysts with the abdominal cavity.

In addition to the above standard techniques, the surgeons at "Top Ichilov" Clinic also perform atypical types of shunting, such as ventriculopleural and ventriculoureteral shunting.

The cerebrospinal fluid shunting systems used during the operation are made from high-quality silicone materials that are inert to the human body. The principle of operation of such systems is based on the use of a unidirectional valve that drains cerebrospinal fluid from the brain ventricles when intracranial pressure exceeds specified levels. A detailed examination of the shunting operation can be illustrated by the most common technique — ventriculoperitoneal shunting. At the beginning of the operation, neurosurgeons create a curved access, after which they make a burr hole. A special catheter is placed in the brain ventricle, after which a subcutaneous tunnel is created using flexible titanium conductors. A second, distal catheter is passed through the created tunnel to the area of the navel. The abdominal catheter is introduced into the abdominal cavity via a trocar.

The duration of the cerebrospinal fluid shunting procedure is 1 — 2 hours, with a recovery period in the hospital of 2 — 3 days.

Cerebrospinal fluid shunting is often used not only as an independent operation but also as an additional procedure in complex treatment.

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