Ventriculoperitoneal Shunts
Angelo Mikrogianakis
Introduction
Hydrocephalus is one of the most common pediatric neurosurgical diseases
Treated with mechanical shunting
Shunt malfunctions significantly impact the quality of life of patients with shunted hydrocephalus
Shunts
The shunt apparatus usually consists of three parts:
A proximal end that is placed into the ventricle and is radio-opaque; this end has multiple small perforations
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
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:
< 2 years of age: 2 years
> 2 years of age: 8-10 years
Clinical Presentation of Shunt Malfunction
Headache, malaise, vomiting
Cushing’s triad: hypertension, bradycardia, irregular respirations
Bulging fontanel, increased head circumference
Sixth nerve palsy: horizontal double vision as the affected eye is unable to abduct (turn outward beyond midline)
Changes in gait, mental status alterationsRelated posts:
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