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Complications from Ventriculostomy and Shunts

Your child may have received a ventriculostomy or shunt to help relieve hydrocephalus, which is the build-up of cerebrospinal fluid (CSF) in the hollow spaces of the brain. The symptoms of hydrocephalus include headache, vomiting, poor appetite and excessive sleeping.

What is a ventriculostomy?

An endoscopic third ventriculostomy is a type of surgery done on some children who have hydrocephalus. Your surgeon will tell you if this surgery is possible for your child.

During a third ventriculostomy, the surgeon makes an opening in the floor of the ventricle at the base of the brain. The CSF is then no longer blocked inside the ventricle. Now it can flow in and around the brain as it should.

This means that the child will not need a shunt, but instead will rely on the opening made by the surgeon during surgery.

Complications of ventriculostomy

It is still very important to watch your child for signs that the pressure is building up again, as it is possible that the ventriculostomy could fail or become blocked. If any signs of hydrocephalus do come back, it is very important to call your surgeon right away so that your child can be checked. The surgeon may decide to redo the ventriculostomy or consider inserting a shunt instead.

What is a shunt?

A shunt is a soft flexible tube that acts like a drainpipe. It provides another pathway for CSF to be drained and absorbed away from the brain. One end of the shunt is placed in one ventricle. The shunt is then threaded under the skin, like a tunnel, to another part of the body. Usually it goes to the abdomen, but sometimes it goes to the lungs and rarely to the heart. The CSF is drained and absorbed into the bloodstream.

Placing a shunt is a common, straighforward procedure in the operating room.

Caring for the shunt at home

  • Keep the area where the shunt is inserted clean.
  • Do not put direct pressure on the shunt.
  • Check with the surgeon to find out how many days your child needs to wait before she may put her head underwater in a bath or pool.
  • Your child can wash her hair with any type of shampoo.
  • Check with the surgeon to find out which sports and activities your child can participate in.

Shunt lengthening

As your child grows, the length of her shunt tubing may become too short. Your child may start to show subtle signs of a decompensated hydrocephalus. These signs may include a change in behaviour patterns or a falloff in school performance. Periodic lengthening of the shunt may be necessary to accommodate your child’s growth. If this is required, surgery will be performed to connect additional tubing to the shunt.

Shunt problems

If your child starts to experience headache, neck pain, nausea, vomiting, loss of consciousness or seizures, she may be experiencing a problem with her shunt. Another possible sign is the development of syrinx, which is the build-up of fluid in the spine, causing decreased sensation in the neck, shoulders and upper arms, or weakness in the arms or legs. Other more subtle symptoms may include a decrease in her intellectual function or school performance.

Shunt problems are usually due to a blockage in the tubing or an infection. When a shunt blockage is suspected, your child’s doctor will first determine the site of the malfunction using a CT scan or MRI scan. A preoperative CSF specimen may be taken from a shunt tap to rule out the possibility of infection.

If a shunt is not working well, your child will need to have an operation to fix the problem.  The neurosurgeon will either clear the blockage or replace the shunt.

Infections

Infection is an important cause of shunt malfunction. Infections are usually from your child’s own bacteria, and not from other people who are sick. If the shunt is infected, your child will need to have an external ventricular drain and take antibiotics. Contact your child’s treatment team if she has any of these symptoms:

Infants:

  • a bulge in the soft spot ( fontanelle) in the head
  • vomiting
  • fever
  • irritability
  • change in appetite
  • “sun-set“ eyes (you can see the white part of the eye at the top)
  • redness or swelling around the shunt tube
  • sleepiness
  • seizures
  • any other concerns you have

Toddlers:

  • vomiting
  • fever
  • sleepiness
  • irritability
  • headaches
  • redness or swelling around the shunt tube
  • loss of coordination
  • seizures
  • any other concerns you have

School-aged children

  • headaches
  • fever
  • nausea or vomiting
  • sleepiness
  • irritability
  • loss of coordination
  • vision problems
  • redness or swelling around the shunt tube
  • decline in school performance
  • feelings of confusion
  • seizures
  • any other concerns you have
 

Eric Bouffet, MD, FRCPC

7/10/2009




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