A ventricular shunt is a tube that is surgically placed in one of the fluid-filled chambers inside the brain (ventricles). The fluid around the brain and the spinal column is called cerebrospinal fluid (CSF). When infection or disease causes an excess of CSF in the ventricles, the shunt is placed to drain it and thereby relieve excess pressure.
A ventricular shunt relieves hydrocephalus, a condition in which there is an increased volume of CSF within the ventricles. In hydrocephalus, pressure from the CSF usually increases. It may be caused by a tumor of the brain or of the membranes covering the brain (meninges), infection of or bleeding into the CSF, or inborn malformations of the brain. Symptoms of hydrocephalus may include headache, personality disturbances and loss of intellectual abilities (dementia), problems in walking, irritability, vomiting, abnormal eye movements, or a low level of consciousness.
Normal pressure hydrocephalus (a condition in which the volume of CSF increases without an increase in pressure) is associated with progressive dementia, problems walking, and loss of bladder control (urinary incontinence). Even though CSF is not thought to be under increased pressure in this condition, it may also be treated by ventricular shunting.
The congenital form of hydrocephalus is believed to occur at an incidence of approximately one to four out of every 1,000 births. The incidence of acquired hydrocephalus is not exactly known. The peak ages for the development of hydrocephalus are in infancy, between four and eight years, and in early adulthood. Normal pressure hydrocephalus generally occurs in patients over the age of 60.
The ventricular shunt tube is placed to drain fluid from the ventricular system in the brain to the cavity of the abdomen or to the large vein in the neck (jugular vein). Therefore, surgical procedures must be done both in the brain and at the drainage site. The tubing contains valves to ensure that fluid can only flow out of the brain and not back into it. The valve can be set at a desired pressure to allow CSF to escape whenever the pressure level is exceeded.
A small reservoir may be attached to the tubing and placed under the scalp. This reservoir allows samples of CSF to be removed with a syringe to check the pressure. Fluid from the reservoir can also be examined for bacteria, cancer cells, blood, or protein, depending on the cause of hydrocephalus. The reservoir may also be used to inject antibiotics for CSF infection or chemotherapy medication for meningeal tumors.
The diagnosis of hydrocephalus should be confirmed by diagnostic imaging techniques, such as computed tomography scan (CT scan) or magnetic resonance imaging (MRI), before the shunting procedure is performed. These techniques will also show any associated brain abnormalities. CSF should be examined if infection or tumor of the meninges is suspected. Patients with dementia or mental retardation should undergo neuropsychological testing to establish a baseline psychological profile before the shunting procedure.
As with any surgical procedure, the surgeon must know about any medications or health problems that may increase the patient's risk. Because infections are both common and serious, antibiotics are often given before and after surgery.
To avoid infections at the shunt site, the area should be kept clean. CSF should be checked periodically by the doctor to be sure there is no infection or bleeding into the shunt. CSF pressure should be checked to be sure the shunt is operating properly. The eyes should be examined regularly because shunt failure may damage the nerve to the eyes (optic nerve). If not treated promptly, damage to the optic nerve causes irreversible loss of vision.
Serious and long-term complications of ventricular shunting are bleeding under the outermost covering of the brain (subdural hematoma), infection, stroke, and shunt failure. When a shunt drains to the abdomen (ventriculoperitoneal shunt), fluid may accumulate in the abdomen or abdominal organs may be injured. If CSF pressure is lowered too much, patients may have severe headaches, often with nausea and vomiting, whenever they sit up or stand.
After shunting, the ventricles get smaller within three or four days. This shrinkage occurs even when hydrocephalus has been present for a year or more. Clinically detectable signs of improvement occur within a few weeks. The cause of hydrocephalus, duration of hydrocephalus before shunting, and associated brain abnormalities affect the outcome.
Of patients with normal pressure hydrocephalus who are treated with shunting, 25–80% experience long-term improvement. Normal pressure hydrocephalus is more likely to improve when it is caused by infection of or bleeding into the CSF than when it occurs without an underlying cause.
Complications of shunting occur in 30% of cases, but only 5% are serious. Infections occur in 5–10% of patients, and as many as 80% of shunts develop a mechanical problem at some point and need to be replaced.
In some cases of hydrocephalus, certain drugs may be administered to temporarily decrease the amount of CSF until surgery can be performed. In patients with hydrocephalus caused by a tumor, removal of the tumor often cures the buildup of CSF. Approximately 25% of patients respond to therapies other than shunt placement.
Patients with normal pressure hydrocephalus may experience a temporary improvement in walking and mental abilities upon the temporary drainage of a moderate amount of CSF. This improvement may be an indication that shunting will improve their condition.
Aldrich, E. Francois, Lawrence S. Chin, Arthur J. DiPatri, and Howard M. Eisenberg. "Hydrocephalus." In Sabiston Textbook of Surgery, edited by Courtney M. Townsend Jr. 16th ed. Philadelphia: W. B. Saunders Company, 2001.
Golden, Jeffery A., and Carsten G. Bonnemann. "Hydrocephalus." In Textbook of Clinical Neurology, edited by Christopher G. Goetz and Eric J. Pappert. Philadelphia: W. B. Saunders Company, 1999.
Hamid, Rukaiya K. A., and Philippa Newfield. "Pediatric Neuroanesthesia: Hydrocephalus." Anesthesiology Clinics of North America 19, no. 2 (June 1, 2001): 207–18.
American Academy of Neurology. 1080 Montreal Ave., St. Paul, MN 55116. (800) 879-1960. http://www.aan.com .
Dalvi, Arif. "Normal Pressure Hydrocephalus." eMedicine , January 14, 2002 [cited May 21, 2003]. http://www.emedicine.com/neuro/topic277.htm .
Hord, Eugenia-Daniela. "Hydrocephalus." eMedicine , January 14, 2002 [cited May 21, 2003]. http://www.emedicine.com/neuro/topic161.htm .
Sgouros, Spyros. "Management of Spina Bifida, Hydrocephalus, and Shunts." eMedicine , May 14, 2003. [cited May 21, 2003]. http://www.emedicine.com/ped/topic2976.htm .
Laurie Barclay, MD Stephanie Dionne Sherk
Ventricular shunting is performed in a hospital operating room by a neurosurgeon, a surgeon who specializes in the treatment of diseases of the brain, spinal cord, and nerves.
thanks
She is now 26 years old. She had a serious malfunction of the valve when she was 14. She is now having problems with headache, passing out and seizures. The doctors that she seen tell here that it is not the shunt but something else causing her problems, but they can not tell her what exactly it is. Do you know if a person can out grow the need for a shunt once you have one. One of the doctors that she saw told her that it looked like she probably didn't even need the shunt.
Any information will be appreciated.
thank you for answering
Thanks Lauren
Thanks Sandy
Can you shed some light on your figure of up to 80%
regards
Andy
Steve
Melbourne Australia
tube is pushing fluid into certain cavities or what may be causing this? It doesn't happen every day, but a couple times a week. I also notice when I walk and exercise, it seems to stop.
I had my original shunt for 27yrs and then fell hitting the back of my head. I just wonder if I fell because the shunt was failing to work or broke and stopped working after the fall.
I fell again 6mos later on the front of on face and was taken to emergency hospital where they
did a CT. I started having balance and memory problems and taken to neurologist, then another CT
showed the ventricles had encreased and so a replacement of the shunt was done. A period of 6mos went by from the first fall and one month after the 2nd fall was the replacement.
I too had a shunt placed on the right side of my head with tubing going down behind my right ear, chest and into my abdomen on October 4th. So, it's been a little over 3 weeks now. I feel pretty queasy too and get sharp jabs in my abdomen. I just saw my surgeon yesterday, and he said there's tubing that winds around in my abdomen that presses on my bowels and other organs and having pain and discomfort is not unusual. He basically said it would eventually subside and I'd get used to it.
I have an incision in my abdomen too and I'm disappointed that it's in such a conspicuous place. Makes bikini wearing a thing of the past I guess. I wish you the best with your recovery and hope your uncomfortable feelings subside soon. Sue
i'm 17 and i have a vp shunt, and i was wondering i've been having like shooting(on and off) pains why is this and also my right eyes optic nerve is enlarged which all my eye docs think it could be glacoma,and they do some tests and it's not,so could this be something wrong with my shunt or what i've never had it replaced!
thanks miranda.
Good luck!!
they avord stress and if so why?
About a month later she had to have another shunt put in, well we were afraid because we didn't want this shunt to become infected as well so we ask how would they know if it was working. They informed us that they would know that she would be having ct regualarly which never happen. Well a couple of weeks later my mom started with the sleeping again when we would try to wake her up she would open her eyes and back to sleep this went on for days. So we ask the doctor's can they check the pressure of her brain. Well upon doing that, they release some fluid and my mom woke up. No my question is If the pressure was building up again that meant the shunt was working?
My mom started sleeping again and this time we notice that she open her eyes and it looked like she was following the ceiling in a circle for a couple of days. Well me and my sister work in the hospital and notice that our mom was having a seizure so we notified the nurse of this and then my mom began biting at her tongue, well within a couple of days after they had been giving my mom advant, the seizure didn't stop. Once she was rushed to the ER, I noticed when I open up my mom's eye's her eye's were bluish grey, when the doctor's came in her began taking this dial and putting up to my mom's head where the shunt was. He informed the other doctor that the dial was sent to high and that it was draining to my of the fluid and that it went into the crainial of her brain, so back to surgery she went. My mom never recovered after that, An EEG was done the next day, we were so upset that we didn't ask for the result of that but I bet there was no brain activity on that scan. If possible can you explain how this could have happen? My family needs closure.
My sister in law had a vp shunt done, now she is developing seizures, headache and symptoms of shunt, i would like to understand that will that effect her married life and what are the of risk involved relating to her life?
My daughter had a VP shunt at birth all was fine for the last 7 years. Last year she had 4 revisions in 3 months. She was diagnosed with split ventricles. The VP shunts was replace with a anti syphoning device and ricum. Since being home for the last 6 month not a day goes by that she doesn't have nausea (without vomitting)some day worse than others. MRI and check-ups say she is "clinically" well. No medications have worked. Doctor can give no answers. My wife and I do not no what to do either. Have you have any success?
s
I went into the Emergency Room at midnight on a sunday, with debilitating headaches, nasuea, couldnt walk without stumbling against a wall, i couldnt see stright, had terrible double vision. I was suffering on my living room floor, on vicodin 3 times a day, then tramadol. I was on muscle relaxers every day. (I had thought this wsas a TMJ headache/migraine) They said in could of went into a coma because of all the pain killers and pressure in my head.
Within 10 hours i was in an emergency surgery to drain the CSF buildup in my ventricles.(after a CT scan showing the buildup.) i had an external drain for about a week, then i had that procedure where they poke a hole in between the 3rd ventricle and the fourth. It failed my head pressure went up to 80 that night.
I then developed Chemical Meningitus, most likely due to the Contrast used or the other 2 surgerys. I was in the hospital for almost another week when they said my white blood cells were down and i was cleared for the instqalation of the VP shunt. i walked out of the ICU the next morning at noon. no wheelchair nothing.
but now-
I get reoccuring buzzing, a slight numb/light headed feeling occasionally. Sharp pain where the shunt is, part of my scalp is still partially numb to the touch. i too felt like my abodomen was swollen, im curious as to if the CSF fluid will build up in my abdomen. I had anxiety before hand and now its 10x worse. they jumped between Ativan, xanax and Klonopin. i dont want to take either benzo. i have found that smoking medical marijuanna releases some of my anxiety about my shunt. ( and TMJ and Muscle Spasms) it was such a scary experience, i was told i might not get my eye sight back.
but anyways, im sorry to hear about all the replacements and malfuntions, im scared of what i have to go though in my future. I do have the newer magnetic shunt, and it seems some people can use those up to 20 years. But who knows
In general, how long does it take for this effect to wear off?
By the way, how come this site doesn't provide access to your responses to others' questions? I think I might have been able to find the answer to my question if I could have seen responses to prior submissions.
Last days, my child was implemented medtronics vp shunt of medium pressure, he is 15 years old and hydrocephalus was diagnosed 2 years before and it was treated through antibiotics before surgery. The thing, i am worried for is my child can't walk normally still after 10 Days. He was having problem with walking alone sometime before surgery but condition was better then what its now.
I would be very much thankful to you, if you can explain this to me and inform me how long it normally takes to be able to walk normally after implementation of vp shut.
Thanks
M. Hafeez
PS, for the family members, specially the parents of the patients having VP shunt, compact quality all in one support are very important for your love one. Thank you for reading this. Take Care.:)
THANKS FOR READING THIS
I've never had problems with mine besides a few headaches, i can lay on the side that my shunt is on. Depending on your shunt it may be partially outside of the skull (mine is, it's soft and squishy).
After so long you kinda forget it's there (until a hairdresser happens to find it, then you have to explain its a shunt;)
I don't know for sure but the pain you guys that recently got the shunt could just be your body adjusting to the fact you have something different chillin inside of your body, however you should probably see a doctor if you're worried or passing out/having seizures :)
Any advise would be greatly appreciated.
I had my vp shunt put in about 4 months ago
And after that my horror started because I can hardly
Get up because of the pain I had to resign from
Work because the pain is just uncontrollable
I started vomiting and forgetting things I can hardly sleep
I'm wondering what's going on because I since
Have never been back to my doctor
It feels like my life is coming to a end from vomiting to headaches to feeling weak
And to feeling moody don't know what's going on I need help the vp shunt is spoiling my life
I'm having this really bad pain in my head and left eye. The doctor is saying I am fine but I know I'm not.
I went back to work where I learned a new Accounting Software. I am now working full time ( Accounting)
I have no deficit mentally or physically.
Barrow wants me to go in for a follow up MRA. This concerns me, since I was told that an MRI would cause the valve to malfunction and they would have to reset it. Do I need to expect the same issue with an MRA.
The valve seems to be functioning so why mess with it. My theory is " If it ain't broke, don't fix it! "
I need to know whether I should just leaqve well enough alone, or go and have the MRA What are the risks?
Thanks
it is bear able but from the last year she had lice bunches of her head, we consult so many Pakistani specialist not effect used all differnet kind of shampoo, medicine no effect for the time being it clean after day of two agin the same bunch of lice even that bugs bigger then lice.
Please let us advice how we could removed completly, or what is the couse.
Thanks
but still she doesn't eat anything.. What should i do? any advise? Is that normal?
Other than the inconvenience of making the trips to a California hospital (LA Children's Hospital) from Las Vegas, where we live, I never allowed this to keep me living a normal life. As a kid I hated having my head shaved but now I keep my head shaved anyway and when people see the scars in the back of my head look at me like I'm a bad-dude or biker, and every now and then, when people may ask what the scars are from I just take the time to make up some crazy story which is always fun. From a Lion attacked me, to a crazy car accident, to I was in Iraq a few years ago. However, I have never stopped living my life. I have lived a normal life and have had much success both personally and professionally. So, do not allow your life or that of your child or relative to be altered by this. Live, love and be an example to others, and take it from someone who did not allow life's circumstance to detour my dreams. If anything, use it as motivation to want to live more.
I hope this will serve peas motivation and drive to accomplish more in your life.
My brother had a shunt put in for hydrocephalus when he was a baby. He is now 37 years old and one year ago, he had a new shunt put in because he was passing out and having seizures, complaining of headaches, vomiting, and had bulging eyes(they didn't want to remove the first shunt due to complications, so they inserted the second shunt). The second shunt is the only shunt being used. At the end of October, he began to seizure again, vomit, and complain about headaches. When he seizures, he becomes completely immobile. The doctors have done CT scans, MRI's, etc. and they say there is nothing wrong with his shunt, but all symptoms are indicative of hydrocephalus. Has anyone experienced this before? If so, what did you do? What was the diagnosis?
My brother had a shunt put in for hydrocephalus when he was a baby. He is now 37 years old and one year ago, he had a new shunt put in because he was passing out and having seizures, complaining of headaches, vomiting, and had bulging eyes(they didn't want to remove the first shunt due to complications, so they inserted the second shunt). The second shunt is the only shunt being used. At the end of October, he began to seizure again, vomit, and complain about headaches. When he seizures, he becomes completely immobile. The doctors have done CT scans, MRI's, etc. and they say there is nothing wrong with his shunt, but all symptoms are indicative of hydrocephalus. Has anyone experienced this before? If so, what did you do? What was the diagnosis?
My daughter is going into surgery tomorrow to have a new shunt placed. She is seven yrs old and never had a problem until now. They just clampped the external ventricular drain. I am so nervous about this. Nurses keep coming in every 15 minutes and taking her vitals. And checking her eyes and asking lots of questions. I'm nit getting very many answers from them. So I'm hoping to find some relief from yall.
after begin found in the CT Scan she got bleeding in the head.Tubing was done two months go this year 2015.She is 70yrs old and already diagnosed with bronchietatsis.Every six months she has to see doctor for her lung problem her right lung is damaged,bcos of this the phlegm will accumulate and she will find difficult to breath and also difficult for her to spit out. Now is having stomach, headaches, right leg and left arm all very painful. X-ray was taken for left arm and it's show a bit dislocated. If there is infections, at the shunt site they will placed the shunt outside.I can see my mum is going through a lots of pains and suffering. She is very weak and eating very little and also her voice is very soft, when she speak i cannot hear what she is saying. I am so worried and confused and thinking that the neurosurgeons is doing the right procedure for my mum or not.Please give some informations on this. I would be very much appreciated.Thank you.
YET within a decade Forrest was able to perform more than 300 shunt surgeries on babies and young children between 1967 and 1973 at WCH SOME (if not MOST) of whom were NOT authentically suffering from ‘hydrocephalus’ as HE had diagnosed and falsely claimed to their unsuspecting parents and families??
But WHY (you ask) would Forrest ‘fake’ the infants symptoms and fool their distraught parents into believing that the surgery to implant a prophylactic Spitz-Holter shunt system was the ONLY way to prevent the death of their child … the only option they had IF their baby was to survive this incurable life-threatening condition??
The answer (I believe) must have initially been for monetary gain and later the added lure of ‘fame’ … Forrest died in 2004 and WAS actually paid tribute to and eulogised for his pioneering paediatric surgical techniques using (specifically) Spitz-Holter shunts to ‘save’ hundreds of young children’s lives … HIS success rate was mightily impressive and soared during the (aforementioned) 6-year period when he (and only HE?) was performing the shunt surgeries which was in stark contrast to the earlier failures and abysmal infant mortality rate that had preceded Forrest’s ‘reign’??
Needless to say that MANY of those infants under Forrest’s care at WCH have long since either died or suffered permanent brain damage as a direct result of his botched and bogus ‘surgeries’ which have subsequently and systematically been covered-up, concealed and disguised by HUNDREDS (if not thousands) of latter-day neurosurgeons and neurologists??
Forrest desecrated and damaged SO MANY young infants bodies and brains UNNECESSARILY that IF the truth were ever to ‘come out’ and be exposed it would add even MORE notoriety and disrepute to the long list the medical profession has already ‘notched-up’??
Anyone reading WHAT I‘ve just written will no doubt think my serious ‘allegations’ to be simply outrageous, unthinkable and inconceivable BUT please rest assured that I have a TON of indisputable evidence which I’ve managed to accumulate over the last FIFTEEN years that ANYONE would find difficult to dispute or doubt??
I cannot emphasise enough to ALL the people above who have sent in their questions and made their worries and concerns known HOW important it is to arm themselves with as MUCH information about hydrocephalus as possible AND the intracranial ‘shunts’ that are invariably implanted to manage the condition??
A good place to start is by purchasing the book ‘HYDROCEPHALUS ~ A Guide for Patients, Families & Friends’ by Chuck Toporek & Kellie Robinson … it’s a rare and very informative book in a world where there seems to be FEW reliable sources of information on this particular subject and I HOPE you find it helpful!!
I go in tommorow morning to have a shunt put in...I have a cyst in my 3rd ventricle and it's not allowing fluids to drain. They are possibly putting in 2..1 on each side.. I was just wondering if they will give you something for pain afterwards or do you tough it out..thanks.
HELP
My father after a peritonitis had to remove his Ventriculo-peritoneal shunt and now they are going to place a Ventriculoatrial shunt. He has a pacemaker. Will the pacemaker complicate the Ventriculoatrial shunt? Please respond! Thank you
The right or left lung was 1 or the upper heart chamber was another option.
I chose the right lung; but have been getting very sharp pains when I breath in and it has also been giving me a shortness of breath.
Three admissions, 14 days in the NCCU, 2 lumbar drains, 10 days on the surgical floor and one VP Shunt later I am home. Saw my neurosurgeon today had my stitches removed.
Surgery on the 14th of July, programmable strata shunt by Medtronic setting 0.5 which is set at the highest amount of drainage possible.
My concern is my short term memory is awful, and unable to find the correct word. I am a Respiratory Therapist, for 26 years, I don't know anything but ICU , ER and night shift. Can anyone share their experiences with memory loss, and remembering words. I have found anything with numbers almost impossible to remember, and why I am doing something, like "Why is the sink on?"
I am really afraid that I won't be able to work, Not a good thing if I can't remember why I walked into a patients room, or manage a ventilator in the ICU.
I am just really concerned?