Ventriculoperitoneal shunt mechanical failure

Background

Causes

• Fracture of tubing
  • Occurs many years after shunt placement in distal tubing
  • May present with mild symptoms of increased ICP and local symptoms of pain, erythema, edema
• Disconnection
  • Occurs shortly after insertion
• Migration
  • Presents as shunt failure
• Misplacement
  • Usually manifests postoperatively

Clinical Features

• Shunt fractures may present with localized symptoms over the area (pain, erythema, fluid at skin)
• Features of raised ICP
  • Bulging fontanelles in infants
  • Irritability, lethargy
  • Headache
  • Nausea and vomiting, poor feeding
  • Seizure
  • Cushing's triad

Differential Diagnosis

Ventriculoperitoneal shunt problems

• Ventriculoperitoneal shunt obstruction
• Ventriculoperitoneal shunt overdrainage (Slit Ventricle Syndrome)
• Ventriculoperitoneal shunt infection
• Ventriculoperitoneal shunt mechanical failure

Evaluation

• Shunt series (AP and lateral x=rays of skull, AP x-rays of chest and abdomen)
• Consider CT Head
• 24% of patients with documented shunt malfunction may show no radiologic evidence of the malfunction on plain films or CT

Management

• Neurosurgery consult
  • If critically high ICP and no neurosurgeon available, may need to tap shunt as temporizing measure

See Also

• Ventriculoperitoneal shunt problems