Shunt

A shunt refers to a tube that surgically placed in the brain or spine hole to drain the excess cerebrospinal fluid (CSF) and redirect it into another location where it can reabsorb ¹. Shunt procedure

helps to relieve pressure from the brain caused by hydrocephalus. Untreated hydrocephalus can lead to many adverse effects including chronic headache, gait difficulty, mild dementia, and lack of bladder control. A shunt comprises three parts: a ventricular catheter, a valve, and a peritoneal catheter. The valve connects the ventricular catheter with the peritoneal catheter, which placed in the peritoneal cavity. This operation requires a neurosurgeon, an anesthesiologist, and a nurse to perform successfully.

Types of Shunts

A recent study shows that every year about 33,000 people performed shunt in the USA. The different shunts include ^1,2:

1. Ventriculoperitoneal (VP) shunt: This VP shunt used to drain excess CSF from the brain and transport it to the peritoneal cavity.
2. Ventriculo-atrial (VA) shunt: This VA shunt finishes the right atrium of the heart and drains the CSF to absorb via the bloodstream.
3. Lumbo-peritoneal (LP) shunt: This comprises a catheter inserted between two lumbar vertebras into the thecal space to drain the excess cerebrospinal fluid from the brain and transport it to the peritoneal cavity.
4. Ventriculo-pleural (VP) shunt: This method used as an alternative for ventriculoperitoneal shunt, where the excess CSF drains into the pleural cavity rather than the peritoneal cavity.
5. Peritoneovenous shunt: Also called Denver shunt, which drains peritoneal fluid from the peritoneum into veins, usually the internal jugular vein or the superior vena cava.
6. Cerebral shunt: This shunt used to drain excess cerebrospinal fluid (CSF) from the brain and carry it to other parts of the body.
7. Portosystemic shunt: Also known as “Liver shunt”, which includes a bypass of the liver by the body’s circulatory system.
8. Portacaval shunt: This shunt used in the treatment for high blood pressure in the liver.

Indications of a Shunt

The most common shunt indications include ^2,3:

• Congenital hydrocephalus
• Normal-pressure hydrocephalus
• Communicating hydrocephalus
• Tumors leading to CSF blockage
• Myelomeningocele
• Arachnoid cysts
• Idiopathic intracranial hypertension
• Dandy-Walker syndrome

Contraindications of a Shunt

The main contradictions of a shunt include:

• Infection over the entry site
• Infection in the CSF
• Allergy to any of the catheter components
• Altered coagulation function
• CSF with blood
• High CSF protein

Complications of Shunt

The major shunt complications include ^4,5:

• Shunt obstruction
• Shunt disconnection
• Infections caused by microorganisms
• Subdural hematoma
• Intracerebral or intraventricular hemorrhage
• Malposition
• Abscess
• Pseudo-cyst
• Peritonitis
• Shunt nephritis
• Seizure
• Multiloculated hydrocephalus
• Abdominal complications
• Catheter perforation of viscera
• Shunt over drainage causes the ventricles to decrease in size
• Shunt under drainage causes the ventricles to increase in size, etc.

How do Neurosurgeons Perform a Shunt Operation

Surgeons require about an hour to perform this shunt operation in the operating room. Afterward, the patient carefully observed for 24 hours. A typical stay of 2 to 4 days requires in hospital after this operation. Post-surgical complications can have dire consequences for the patient with shunt operation. The nurse needs to monitor the patient continuously for any sign of these complications during his stay in the hospital. If any complications arise, they need to act immediately ⁴. Follow-up visits may help the doctor ensure that the shunt working properly and continuing to relieve hydrocephalus symptoms. In addition, the care team recommends performing physical therapy, occupational therapy, and other exercise techniques to help resolve symptoms as soon as possible.

References

1. Naradzay JFX, Browne BJ, Rolnick MA, Doherty RJ. Cerebral ventricular shunts. Journal of Emergency Medicine. 1999;17(2):311–322. doi:10.1016/S0736-4679(98)00168-1
2. Marupudi NI, Harris C, Pavri T, Mell B, Singh R, Ham SD, Sood S. The role of lumboperitoneal shunts in managing chronic hydrocephalus with slit ventricles. Journal of Neurosurgery: Pediatrics. 2018;22(6):632–637. doi:10.3171/2018.6.PEDS17642
3. Wetzel JS, Waldman AD, Texakalidis P, Buster B, Eshraghi SR, Wheelus J, Reisner A, Chern JJ. Survival and failure trends of cerebrospinal fluid shunts with distal slit valves: Comparative study and literature review. Journal of Neurosurgery: Pediatrics. 2020;25(3):209–216. doi:10.3171/2019.9.PEDS18579
4. Hanak BW, Bonow RH, Harris CA, Browd SR. Cerebrospinal Fluid Shunting Complications in Children. Pediatric Neurosurgery. 2017;52(6):381–400. doi:10.1159/000452840
5. Craven C, Asif H, Farrukh A, Somavilla F, Toma AK, Watkins L. Case series of ventriculopleural shunts in adults: A single-center experience. Journal of Neurosurgery. 2017;126(6):2010–2016. doi:10.3171/2016.4.JNS16641