CSF shunts

Key points

Normal Intra-cranial pressures

1.5-6mmHg term infant

3-7mmHg young children

7-15 mmHg in adults

Communicating hydrocephalus: all ventricles large, could be decreased absorption of CSF e.g. Meningitis, bleed

Types of shunt

Ventriculoperitoneal (VP)

Ventriculoatrial (VA)

Ventriculopleural (VPL)

Paediatric Surgery involvement

VP shunts may be tunnelled down the right anterior neck - should be avoided when inserting a right sided hickman line (may need to go on the other side)

Intra-abdominal sepsis in a patient with a VP shunt - may be intra-abdominal cause e.g. appendicitis, or shunt infection

Obtain imaging, discuss with neurosurgery

They may need to tap and culture or exteriorise the shunt

When performing a procedure which may result in contamination of a VP shunt, it may need to be exteriorised first

Patients with previous abdominal surgery - may need paediatric surgery assistance in placing VP shunt - either laparoscopic or open

An intra-abdominal collection of CSF may accumulate in patients with adhesions

This can be drained by exteriorising the shunt, then opening where it enters the abdomen, dividing it and using the distal end as a drain for several days before a shunt revision

References

Nag, D.S., Sahu, S., Swain, A., & Kant, S. (2019). Intracranial pressure monitoring: Gold standard and recent innovations. World Journal of Clinical Cases, 7, 1535 - 1553.