Ventricular Peritoneal Shunts
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Basics
Description
- Ventricular peritoneal (VP) shunts are usually placed for hydrocephalus:
- Conduit between CSF and peritoneal cavity (or right atrium-VA shunt))
- Complications requiring revision are common, especially in the first 6 mo after placement
- Obstruction: Shunt malfunction impairs drainage of CSF:
- Increases intracranial pressure (ICP)
- Rate of increase in ICP determines severity
- 30–40% mechanical malfunction rate in first year
- Overdrainage syndrome:
- Upright posture increases CSF outflow
- Decreases ICP
- Produces postural headache and nausea (as after lumbar puncture)
- Infection:
- Shunt is a foreign body
- Staphylococcus epidermidis and other Staphylococcus species in 75% of infections
- Gram-negative organisms also implicated
- Multidrug-resistant Staphylococcus aureus (MRSA) has been reported
- Most occur soon after placement
- Shunt removal usually required
- Slit ventricle syndrome:
- Prolonged overdrainage causes decreased ventricular size
- Intermittent increases in ICP occur owing to proximal obstruction
Pediatric Considerations
- Complications more common in children, especially neonates
- If cranial sutures are open, CSF may accumulate without much ICP increase
- Produces relatively nonspecific signs and symptoms:
- Drowsy
- Headache
- Nausea and vomiting
Etiology
- Shunt may be needed to treat increased ICP due to:
- Congenital malformations
- Idiopathic intracranial hypertension (pseudotumor cerebri)
- Post CVA
- Tumor or other mass lesions
- Post head trauma
- Subarachnoid hemorrhage
- Scarring at base of brain after bacterial meningitis
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Ventricular peritoneal (VP) shunts are usually placed for hydrocephalus:
- Conduit between CSF and peritoneal cavity (or right atrium-VA shunt))
- Complications requiring revision are common, especially in the first 6 mo after placement
- Obstruction: Shunt malfunction impairs drainage of CSF:
- Increases intracranial pressure (ICP)
- Rate of increase in ICP determines severity
- 30–40% mechanical malfunction rate in first year
- Overdrainage syndrome:
- Upright posture increases CSF outflow
- Decreases ICP
- Produces postural headache and nausea (as after lumbar puncture)
- Infection:
- Shunt is a foreign body
- Staphylococcus epidermidis and other Staphylococcus species in 75% of infections
- Gram-negative organisms also implicated
- Multidrug-resistant Staphylococcus aureus (MRSA) has been reported
- Most occur soon after placement
- Shunt removal usually required
- Slit ventricle syndrome:
- Prolonged overdrainage causes decreased ventricular size
- Intermittent increases in ICP occur owing to proximal obstruction
Pediatric Considerations
- Complications more common in children, especially neonates
- If cranial sutures are open, CSF may accumulate without much ICP increase
- Produces relatively nonspecific signs and symptoms:
- Drowsy
- Headache
- Nausea and vomiting
Etiology
- Shunt may be needed to treat increased ICP due to:
- Congenital malformations
- Idiopathic intracranial hypertension (pseudotumor cerebri)
- Post CVA
- Tumor or other mass lesions
- Post head trauma
- Subarachnoid hemorrhage
- Scarring at base of brain after bacterial meningitis
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