Brain Shunting in Israel

Professor Itzhak Fried

Head of the Functional Neurosurgery Department

There are many factors that lead to disruption of cerebrospinal fluid circulation, the main ones include:

• traumatic brain injuries,
• brain tumors;
• 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 absorption 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 cerebrospinal fluid pressure. The essence of shunting is that excess cerebrospinal fluid is removed from the brain's ventricles into the body's cavities through a system of valves and tubes.

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

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

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

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

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

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

In addition to the standard techniques mentioned above, surgeons at the "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's ventricles when predetermined intracranial pressure levels are exceeded. A more detailed examination of the cerebrospinal fluid shunting procedure can be illustrated using the most common technique — ventriculoperitoneal shunting. At the beginning of the operation, neurosurgeons create an arcuate access, after which they make a burr hole. A special catheter is placed in the brain's ventricle, followed by the creation of a subcutaneous tunnel using flexible titanium conductors. A second, distal catheter is then passed through the 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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