Shunt Revision

Surgical repair or replacement of a hydrocephalus shunt that is obstructed, infected, or malfunctioning.

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CSF Dynamics and Hydrocephalus

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1Overview

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What is this Condition?

Shunt revision is the surgical correction of problems that develop over time in a shunt system placed due to hydrocephalus. A shunt is a mechanical system that can become obstructed, infected, fractured, displaced, or over-drain fluid over the years. For this reason, a significant proportion of shunt patients require at least one revision during their lifetime; in children, this occurs more frequently due to rapid growth. The most common cause is tube obstruction. Depending on the type of problem, only the obstructed part or the entire system may be replaced. Revision is a frequently performed procedure in neurosurgery, and symptoms usually resolve once the problem is corrected.

Symptoms

Sudden and severe headache, projectile vomiting (acute obstruction)

Drowsiness, altered consciousness, fontanelle bulging in infants

Morning-worsening chronic headache, decline in attention and school performance

Blurred vision, double vision

Fever, redness or drainage along the catheter tract (signs of infection)

Subcutaneous swelling along the catheter tract or displacement of the shunt

Diagnosis Methods

Diagnosis begins with physical examination and assessment of symptom onset. Brain CT is compared with previous imaging to determine if the ventricles have enlarged. Plain radiographs showing the entire shunt system are used to detect fractures, displacement, or disconnection. Shunt reservoir tap test, fluid aspiration for pressure and content measurement, and flow studies are employed as needed. Fluid and blood cultures are obtained if infection is suspected.

Treatment Methods

Treatment is planned according to the problem. Acute obstruction is an emergency requiring prompt surgery; the obstructed portion of the tube is replaced. If the valve is malfunctioning, a programmable valve with externally adjustable pressure may be preferred. If the tube is fractured or displaced, it is repaired or replaced. If infection is present, the entire shunt is removed, fluid is temporarily drained externally, and antibiotics are administered intravenously; once the fluid is sterilized, a new shunt is placed. If over-drainage is present, the valve pressure is increased.

Replacement of the obstructed brain-side catheter

Placement of the abdominal catheter in a different location, if necessary using a closed technique

Replacement of the malfunctioning valve with a programmable valve

Shunt removal in infection, antibiotic therapy, and subsequent new shunt placement

Treatment Path

Related Treatments

The procedures and interventions most commonly explored with this condition.

4 links

Shunt Placement

Shunt Placement procedure

Open treatment detail

Endoscopic Third Ventriculostomy

Endoscopic Third Ventriculostomy procedure

Open treatment detail

Endoscopic Aqueductoplasty

Endoscopic Aqueductoplasty procedure

Open treatment detail

External Ventricular Drainage

External Ventricular Drainage procedure

Open treatment detail

References

Tanrıkulu B, Özek MM. Complications of Shunt Systems and Their Management (Shunt Obstruction, Mechanical Complications). In: Cinalli G, Özek MM, Sainte-Rose C, eds. Pediatric Hydrocephalus. 2nd ed. Cham: Springer; 2019.
Winn HR, ed. Hydrocephalus and Shunt Malfunction / Complications. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011.
Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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Shunt Revision

CSF Dynamics and Hydrocephalus

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Related Treatments

Shunt Placement

Endoscopic Third Ventriculostomy

Endoscopic Aqueductoplasty

External Ventricular Drainage

References

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Shunt Placement

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