5-Minute Emergency Consult
Ventricular Peritoneal Shunts
Ventricular Peritoneal Shunts is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
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
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
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
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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Citation
Schaider, Jeffrey J., et al., editors. "Ventricular Peritoneal Shunts." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307464/all/Ventricular_Peritoneal_Shunts.
Ventricular Peritoneal Shunts. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307464/all/Ventricular_Peritoneal_Shunts. Accessed March 24, 2023.
Ventricular Peritoneal Shunts. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307464/all/Ventricular_Peritoneal_Shunts
Ventricular Peritoneal Shunts [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 March 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307464/all/Ventricular_Peritoneal_Shunts.
* Article titles in AMA citation format should be in sentence-case
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T1 - Ventricular Peritoneal Shunts
ID - 307464
ED - Barkin,Adam Z,
ED - Shayne,Philip,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307464/all/Ventricular_Peritoneal_Shunts
PB - Lippincott Williams & Wilkins
ET - 5
DB - Emergency Central
DP - Unbound Medicine
ER -
