Hydrocephalus and Shunts – Spina Bifida Association

Like a bathtub with the water system on and a partially clogged drain, fluid can ’ t drain fast enough. The purpose of CSF is to protect the brain and spinal cord. When there is besides much fluid, it can be dangerous .
Most of the time, it is easy for doctors to see that there is excessively much on the brain. There are pockets called ventricles that get big when there is excessively much CSF in them. In some cases, it isn ’ t as easy to see. There may be a little more fluid than normal, and the person has fiddling or no signs of a problem. Because of the complexity, a neurosurgeon is the best person to diagnosis and dainty hydrocephalus .
The most common discussion for hydrocephalus is to insert a tube, called a shunt, to drain overindulgence fluid from the mind to another identify where the torso can remove it naturally. Shunts have valves that regulate both the direction and total of fluid that is drained. Shunts have three parts :
1 ) a ventricular catheter to reach the sphere where there is excessively much fluid

2 ) a valve to control flow ( there are many types )
3 ) tubing to carry the fluid from one identify in the body to another .

Types of shunts

The most common type of shunt is the ventriculo-peritoneal ( VP ) shunt. This shunt drains from the ventricle to the abdomen. early types that are less coarse are :

  • Ventriculoatrial (VA) shunts—VA shunts move the to a vein, usually in the neck or under the collarbone
  • Ventriculo-pleural shunts—These shunts move fluid to the chest around the lungs
  • Ventriculo-gall bladder shunts—These shunts move to the gall bladder

There are respective types of shunt valves. All of them work by controlling the amount of fluid that is drained. Most are made to work automatically when fluid pressure in the capitulum gets excessively high. Some valves besides may have extra devices to keep excessively a lot fluid from draining. Experts have not even learned which type of shunt is best for whom .
Neurosurgeons normally pick ones that they think are best. Shunts can be put into one of these places in the head :

  • The edge of the soft spot
  • Above and behind the ear
  • The back of the head

Experts don ’ thymine know if one topographic point is better than another. so where to put the shunt besides is up to what the surgeon thinks is best. Almost all shunts are put in during the beginning days or weeks after parentage. Sometimes the shunt will be inserted at the fourth dimension of the initial spinal column blockage. A child who doesn ’ t need a shunt by the prison term they are 5 months erstwhile credibly will never need one .
Signs of shunt problems
Signs of hydrocephalus ( or of shunt malfunction ) in infants may include :

  • Rapid head growth
  • Full or tense soft spot (fontanelle)
  • Unusual irritability
  • Repeated vomiting
  • Crossed eyes
  • An inability to look up
  • Periods in which the baby stops breathing (called apnea) swallowing
  • A hoarse or weak cry in keeping the infant awake
  • Any worsening brain function

A point sonography, Computed Tomography ( CT ) scan or a magnetic resonance Imaging ( MRI ) scan will show this build-up, but a shunt still may not be working right even if it doesn ’ t show up on a CT or MRI scan. New, long-run treatments using little endoscopes may eliminate the need for a shunt. All patients with hydrocephalus should be seen by a neurosurgeon at least every one to two years .
Most people with Spina Bifida and shunted hydrocephalus will need the shunt for life. The most coarse problem with shunts is that they can get blocked up, respite or hail apart. About 40 percentage of shunts will fail and need changing ( or revision ) within one year, 60 percentage within years and 80–85 percentage within 10 years. About 20 percentage of people with Spina Bifida will need more than one shunt rewrite .
The signs of shunt problems in people with Spina Bifida are different for each person. This can make it hard for families and health care providers to know what ’ s going on. The most coarse sign of a shunt problem is a concern. Vomiting and nausea can happen, excessively, but not constantly. Less common signs of a shunt trouble include :

  • Seizures (either the onset of new seizures or an increase in the frequency of existing seizures)
  • A change in intellect, school performance or personality
  • Back pain at the spine closure site
  • Worsening arm or leg function (increasing weakness or loss of sensation, worsening coordination or balance and/ or worsening orthopedic deformities)
  • Increasing scoliosis
  • Worsening speech or swallowing
  • Changes in bowel or bladder function

Shunt malfunction can look like any of the signs of a Chiari malformation or spinal anesthesia cord tether. When the mind or spinal cord function gets worse, and there is no other clear cause, health caution providers should check to see if there are shunt problems .
To see if there is a problem with a shunt, health manage providers will study images of the brain ( normally a connecticut scan or, for children under one class, a head ultrasound ) .
When ventricles start to get excessively big, it is a strong polarity that the shunt is not working properly. It is important to know that some people ( between 5 and 15 percentage ) with Spina Bifida may have very few signs or even no visible variety in the size of the ventricles when the shunt is not working correctly. On the early hand, some people with shunt hydrocephalus can develop the cunt ( or cadaver ) ventricle syndrome. For these people, excessively much fluid drain leads to very small ( or slit ) ventricles. In these cases, experts think that the walls of the ventricles temporarily block the shunt catheter. This leads to a series of temp shunt malfunctions without any visible increase in the size of the ventricles .
Families and health manage providers must pay close attention to a person ’ mho symptoms, particularly if they are exchangeable to those that were present with former shunt problems .


infection is a major problem that can happen with shunt operations. Between 5 and 10 percentage of people will have this problem. Shunt infections are higher in babies than in older children and adults. Seventy percentage of shunt infections happen within the first two months after a shunt operation. Eighty percentage of these infections develop within the inaugural six months. Skin bacteria ( Staphylococcus epidermis ) are the most common causes of shunt contagion. Half of people with shunt infections show signs of a shunt malfunction. Additional signs of an infection include :

  • Fever
  • Neck stiffness
  • Pain
  • Tenderness
  • Redness
  • Drainage from the shunt incisions or tract
  • Abdominal pain

The diagnosis can be checked by putting a belittled needle into the valve or a chamber of the shunt and taking out fluid for sketch. Infections are normally treated with antibiotics and with removal and substitute of the shunt system. There are two ways of doing this. The first is to take out the shunt system and then put in a irregular external drain tube at the like time that antibiotics are given. When the treatment is done, the tube is taken out, and a new shunt is put back in. This about always stops the infection, but it takes two operations.

The irregular ( assuming that the shunt is working ) is to keep the infect shunt in until the end of the antibiotic treatment. then the infect shunt is removed and replaced with a new one. The second gear means lone takes one operation, but it does not get rid of the infection angstrom much as the first .

Making decisions

The opinion of a health care supplier is very authoritative when working with person with Spina Bifida and shunted hydrocephalus. When making decisions, here is some helpful advice to families and health care providers :

  • Pay attention to a parent’s gut feeling about shunt problems—these feelings are usually right
  • Be aware that shunt problems can cause many symptoms that may not be obviously shunt-related
  • Be on the lookout for shunt problems, and make sure the shunt is working OK before performing other neurosurgical treatments

This information does not constitute checkup advice for any individual. As specific cases may vary from the general data presented here, SBA advises readers to consult a flinch medical or early professionals on an individual basis .

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