Ventricular shunt




Definition

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.


Purpose

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.


Demographics

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.


Description

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.


Diagnosis/Preparation

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.

Aftercare

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.


Risks

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.


Normal results

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.

Morbidity and mortality rates

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.


Alternatives

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.


Resources

BOOKS

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.

PERIODICALS

Hamid, Rukaiya K. A., and Philippa Newfield. "Pediatric Neuroanesthesia: Hydrocephalus." Anesthesiology Clinics of North America 19, no. 2 (June 1, 2001): 207–18.

ORGANIZATIONS

American Academy of Neurology. 1080 Montreal Ave., St. Paul, MN 55116. (800) 879-1960. http://www.aan.com .


OTHER

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

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?



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.

QUESTIONS TO ASK THE DOCTOR



  • Why is a ventricular shunt recommended in my case?
  • What is the cause of the hydrocephalus?
  • What diagnostic tests will be performed prior to the shunt being placed?
  • Where will the shunt be placed?
  • Are there any alternatives to a ventricular shunt?

User Contributions:

Jane Smith
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Jul 21, 2006 @ 8:20 pm
I have appreciated this article very much. Thank you for the simple explanations, and especially the statistics, which have given me a clearer idea of the prognosis for my baby.
magalie serus
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Apr 7, 2007 @ 2:14 pm
Dear,

can larger ventricules, du to a blocage of the drainage of the spinal fluid, can cause pressure on the head and as a consequence cause seizures???

Can a ventricular shunt surgergy make the seizures slow down or disapear??

thank you for answering
kind reagards
mrs serus
Donna
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Jun 11, 2007 @ 11:23 pm
IS IT DANGEROUS TO REMOVE A SHUNT FROM A 4 YR OLD,HE HAS HAD IT FOR 2 YR S OR MORE.THE DR S SAY HE IS DOING FINE AND IT IS UP TO THE PARENT S TO HAVE IT REMOVED
donna weaver
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Jul 18, 2007 @ 2:14 pm
My father(80) about a month ago had a shunt put in the back of his head because he was diagnosed with NPH. He has been complaining about double vision, words and numbers waving, words disappearing, and having a hard time figuring out numbers. His surgeon says to wait and see if it gets better but you say here " 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." Should we be worried? How lomg do we wait?
leanne
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Nov 5, 2007 @ 3:15 pm
can you get pains in your testicals after having a shut and a catheter fitted
JENNIFER SHAW
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Feb 21, 2008 @ 11:11 am
I HAVE HAD A SHUNT FITTED SINCE BIRTH,THE SECOND ONE WAS 16YEARS AGO.POSIBLY ONCE A YEAR I HAVE A VIOLENT HEADACHE WHICH FEELS LIKE MY HEAD IS BEING CRUSHED,AFTER A FEW HOURS I FELT DIZZY AND SICK,SO I MADE MYSELF VOMIT AND STRAIGHT AWAY THE HEADACHE HAD GONE.WHAT COULD THIS MEAN
percy kim
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Sep 14, 2008 @ 9:21 pm
my son has a shunt in his head for about 6years and today he is getting like little sharp needle poking where his shunt is. we are calling for medical advice. what could be doing this??? please reply.
thanks
Mary
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Sep 19, 2008 @ 1:13 pm
My child has had a ventricular shunt since she was 18 months old.
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.
Bennie
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Jan 15, 2009 @ 10:10 am
mY SHUNTS HAVE BEEN CHANGED SO MANY TIMES AND I CONTINUE TO HAVE DISTORTED EYES, SEVERE HEADACHES, PARACETAMOL DOES NOT WORK ANY MORE FOR ME THE LUMBAR PUNCTURES JUST HELP ME FOR A WHILE AND THEN ALL THE PROBLEMS STARTS AGAIN, CAN YOU HELP ME I AM DESPERATE THANKS BYE
ya
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May 1, 2009 @ 2:14 pm
there is spaciel prosedure in NM ?

thank you for answering
Mike
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May 22, 2009 @ 12:12 pm
My infant daughter had blood that got into her CSF it then clot the ventricles and they cant drain. The doctors want to but a permanent shunt into her abdomen. Is this a common procedure for a baby that is only one week old or is there other options? Will the shunt affect her ability's for the rest of her life. She is perfectly normal now. Thanks you Mike
Lauren McGowan
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Jul 21, 2009 @ 12:12 pm
My daughter, now 23 years, had an unusual symptom which others may wish to note. The CSF passed from her abdominal cavity to her pleural (lung) cavity, putting pressure on the lungs. So, although rare, this did happen and was corrected.
Thanks Lauren
Cherie
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Jul 30, 2009 @ 5:17 pm
A friend's daughter had a right ventricular shunt installed when she was three. Although it is no longer functional, the mother was advised against having removed. The child was born three months preterm with severe complications. The girl is now 16 and her scoliosis is getting worse. Could this be due to the shunt adhereing internally and not allowing the spinal column to grow naturally? Could the tubing be "snipped" where it disappears under the clavicle to release the restrictions? The girl is also having increased temporal lobe seizures. The tubing follows her SCM from the temporal plate to the clavicle.
rajiv bhasin
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Jul 31, 2009 @ 1:01 am
thank u for the simple explanations..this article has helped me alot..cheerz
wonder
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Oct 16, 2009 @ 7:07 am
My father is having a shunt put in today from his head to his tummy because he had a coil put in and the spinal fluid builds up in the head what are the risks? Does he have a time limit or can he live forever? i hate asking that question but I would like to know for my self please reply thank you
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Feb 19, 2010 @ 9:09 am
I had a shunt put in my head 4 1/2 years ago and just recently I've been having dizziness, stomach upset and my shunt feels weird. Is this a sign there might be something wrong?
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Feb 19, 2010 @ 10:22 pm
My grandson was born premature at 24 months. Consequently his brain bleed required him to have a shunt in his brain to drain excess CSF. He is now 14 months and on 4th shunt replacement, 3 within the last 2 months. His curent shunt seems to be working but now is not holding down his food. The Dr. is using a binding on his stomach to assist the shunt to lower the pressure. I am not clear how this should work and am a little worried about this experiment. Has anyone else had this method used sucessfully ??
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Feb 25, 2010 @ 10:10 am
I had a shunt about 3 yrs ago. I am having severe headaches and stabbing leg pain. The headache always seem to be late afternoon or night. My shoulders, arms and back are numb and tingleing. Please advise if this could be caused by the shunt not draining properly.
Thanks Sandy
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May 11, 2010 @ 8:08 am
You state 'as many as 80% of shunts develop a mechanical problem at some point and need to be replaced'. My wife has recently had to have her shunt replaced, however the Royal Free Hospital in London, when asked in November 09 about the reliability of shunts and how often do they need replacing informed our GP that they very rarely fail!!
Can you shed some light on your figure of up to 80%
regards
Andy
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May 13, 2010 @ 9:21 pm
what is a shunt for and what is it used for, is the surgery very dangerous???
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Jun 20, 2010 @ 7:07 am
I have had mine since 1976 when I was 8yrs old since then I have had 10 ventricular shunt replacesments.Why do they keep failing or quit working what is the normal age of a shunt
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Jun 26, 2010 @ 4:16 pm
Seventeen years ago my son had a shunt put in prior to brain surgery for removal of a benign epidermoid tumor that was blocking the flow of CSF. The surgeon said he got all of the tumor and several MRIs over the years have indicated no recurrence of the tumor. A few days ago the plastic shunt tubing split in his neck and is causing pain at the breakage point. My question is what would be recommended to relieve his discomfort. Like many young Americans, he has no health insurance so this will be an out of pocket expence. Could only the plastic tubing be removed or should the entire valve and catheder also be removed? Can it be done as an outpatient procedure or is hospitalization required?
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Jun 29, 2010 @ 1:01 am
My 6 year old had a shunt fitted at 3 weeks old. She has complained the shunt is sore, has had vomiting and headache, but not too severe. Is there a chance the shunt could be blocked

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