Ventriculoperitoneal shunt complications: Difference between revisions

Line 14: Line 14:
==Differential Diagnosis==
==Differential Diagnosis==
{{VP shunt prob DDX}}
{{VP shunt prob DDX}}
==Mechanical Failure==
**Fracture of tubing
***Occurs many years after shunt placement in distal tubing
***May present w/ mild symptoms of incr ICP and local symptoms of pain, erythema, edema
***Occurs shortly after insertion
***Usually manifests postoperatively

==Loculation of Ventricles==
==Loculation of Ventricles==

Revision as of 14:03, 18 July 2015


  • Also called a cerebral sinus fluid (CSF), VP, or cerebral shunt
  • Highest incidence of postoperative complications of any neurosurgical procedure
  • May drain into peritoneal cavity or less commonly the R atrium, pleural cavity, ureter, GB

Clinical Features

  • Develop over several days
  • Adults
    • Cephalgia, N/V, lethargy, ataxia, altered mental status
    • Paralysis of upward gaze, dilated pupilsCN palsies
  • Infants
    • Vomiting, irritability, bulging fontanelle

Differential Diagnosis

Ventriculoperitoneal shunt problems

Loculation of Ventricles

  • Separate, noncommunicating CSF accumulations may develop within a ventricle
    • Shunt device unable to drain entire ventricular system -> incr ICP

Abdominal Complications

  • Pseudocyst may form around the peritoneal catheter
    • Can lead to occlusion and/or abdominal pain (depending on size)


  • Physical Exam
    • Neither Sn nor Sp
    • Locate valve chamber
      • Gently compress chamber and observe for refill
      • Difficulty compressing chamber indicates distal flow obstruction
      • Slow refill (>3s) indicates proximal obstruction
  • Imaging
    • Shunt series
      • AP and lateral skull, AP chest and abdomen
      • Identifies kinking, migration, or disconnection
    • CT
      • Needed to evaluate ventricular size
      • Very helpful to compare to previous study (many pts w/ shunts have abnormal baseline)


See Also

CSF Studies