Ventriculoperitoneal shunt complications: Difference between revisions

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==References==
==References==
<references/>


[[Category:Neuro]]
[[Category:Neuro]]

Revision as of 12:00, 1 December 2015

Background

Diagram showing a brain shunt CRUK 052.svg.png
  • Also called a cerebral sinus fluid (CSF), VP, or cerebral shunt
  • Highest incidence of postoperative complications of any neurosurgical procedure
    • Majority in the first 2 years (40% in the first year[1])
  • May drain into peritoneal cavity or less commonly the R atrium, pleural cavity, ureter, GB
Vpvalve.png

Clinical Features

  • Develop over several days
  • Adults
    • Cephalgia, N/V, lethargy, ataxia, altered mental status
    • Paralysis of upward gaze ("sunset eyes"), dilated pupils, CN palsies
  • Infants
    • Vomiting, irritability, bulging fontanelle
    • Often very subtle: a caregiver-reported change in behavior predicts malfunction

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)

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)
    • If the baby has an open fontanelle, you may use US

Management

  • Assume shunt malfunction in pts w/ suggestive features regardless of findings on imaging
  • Revisions are extremely common, low threshold to contact Neurosurgery
  • Ventriculoperitoneal shunt drainage

See Also

References

  1. Drake JM, Kestle JRW, Tuli S. CSF shunts 50 years on past, present and future. Child’s Nerv Syst. 2000; 16:800–804.