Ventriculoperitoneal Shunts
Angelo Mikrogianakis
Introduction
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Hydrocephalus is one of the most common pediatric neurosurgical diseases
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Treated with mechanical shunting
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Shunt malfunctions significantly impact the quality of life of patients with shunted hydrocephalus
Shunts
The shunt apparatus usually consists of three parts:
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A proximal end that is placed into the ventricle and is radio-opaque; this end has multiple small perforations
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A valve to allow unidirectional flow: can be adjusted for various opening pressures and usually has a reservoir that allows for checking shunt pressure and sampling CSF
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A distal end that is placed into the peritoneum or another absorptive surface by tracking the tubing under the skin
Shunt Malfunctions
The median survival of a shunt before it requires revision:
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< 2 years of age: 2 years
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> 2 years of age: 8-10 years
Clinical Presentation of Shunt Malfunction
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Headache, malaise, vomiting
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Cushing’s triad: hypertension, bradycardia, irregular respirations
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Bulging fontanel, increased head circumference
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Sixth nerve palsy: horizontal double vision as the affected eye is unable to abduct (turn outward beyond midline)
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Changes in gait, mental status alterations
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