Ventriculoperitoneal shunt complications: Difference between revisions
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{{VP shunt prob DDX}} | {{VP shunt prob DDX}} | ||
==Loculation of Ventricles== | ===Loculation of Ventricles=== | ||
*Separate, noncommunicating CSF accumulations may develop within a ventricle | *Separate, noncommunicating CSF accumulations may develop within a ventricle | ||
**Shunt device unable to drain entire ventricular system -> incr ICP | **Shunt device unable to drain entire ventricular system -> incr ICP | ||
==Abdominal Complications== | ===Abdominal Complications=== | ||
*Pseudocyst may form around the peritoneal catheter | *Pseudocyst may form around the peritoneal catheter | ||
**Can lead to occlusion and/or abdominal pain (depending on size) | **Can lead to occlusion and/or abdominal pain (depending on size) |
Revision as of 14:05, 18 July 2015
Background
- 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
- Ventriculoperitoneal shunt obstruction
- Ventriculoperitoneal shunt overdrainage (Slit Ventricle Syndrome)
- Ventriculoperitoneal shunt infection
- Ventriculoperitoneal shunt mechanical failure
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)
Diagnosis
- 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)
- Shunt series
Management
- Assume shunt malfunction in pts w/ suggestive features regardless of findings on imaging
- Ventriculoperitoneal shunt drainage
See Also
Source
Tintinalli