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Normal Anatomy
The cerebrospinal fluid (CSF) bathes the brain and spinal cord. Most of the CSF is located in the ventricles of the brain, which are large cavities in the brain that produce the CSF.
In hydrocephalus, the ventricles of the brain become enlarged with cerebrospinal fluid. This condition causes the brain tissue to compress against the skull, causing serious neurological problems.
Normal CT brain
There are numerous causes for hydrocephalus depending on the age group. In adults, common causes including bleeding inside the ventricles, infection (eg. meningitis), tumour causing obstruction, etc. In children, there are other rarer congenital causes. In the elderly, a condition called normal pressure hydrocephalus may require a VP shunt.
Procedure
Shunting, also called ventriculo-peritoneal shunting, is necessary in order to drain the excess fluid and relieve pressure in the brain A catheter is inserted into the brain to drain CSF from the ventricular system into the abdominal cavity while the patient is deep asleep under general anaesthesia
A Patient / Family Informed Consent Guide to VP Shunt Insertion
Operation Risks
The operation is generally a safe operation with low surgical risk Some of the risks encountered are as follows : 1) Ileus 2) Infection 3) Obstruction 4) Malplacement 5) Wound breakdown with exposed shunt tubing Rare but potentially more serious complications are listed below 1) Subdural hematoma 2) Intracranial hematoma 3) Bowel injury
Operation Risks
Ileus
As the abdominal cavity is entered during operation, some patients may have slow gastric and bowel movement post operation and may feeling of nausea and vomiting. They may not tolerate full meals immediately post operation. These symptoms usually resolve spontaneously over time
Infection
Post operation symptoms and signs would include fever, vomiting, neck stiffness, redness along the shunt tract Most common organisms are S. epidermidis and S. aureus Treatment would be intravenous antibiotics, external ventricular drainage and removal of shunt
Obstruction
Most often due to the head tip is obstructed with cells, choroid plexus, or debris. Diagnosis is based on recurrent signs of headache, vomiting and drowsiness confirmed by CT scan of the head or lumbar puncture Treatment usually entails revision of shunt
Operation Risks
Malplacement This occurs when the ventricular or peritoneal end of the shunt tubing is in a position which does not facilitate free flow of CSF. The result is poor CSF drainage and hydrocephalus does not resolve. Wound breakdown/shunt tube exposure This can occur when the wound does not heal well or the overlying skin is thin with minimal subcutaneous tissue layer resulting in wound breakdown. Some Risk factors malnourishment, debilitated condition, prolonged steroid usage.