When the infection has cleared, the new shunt is implanted surgically. Shunt infections can be an emergency and require immediate medical attention to avoid life-threatening complications or possible brain damage. Over drainage causes the ventricles to decrease in size and may create slit-like ventricles as a result of excessive drainage of CSF. Slit ventricles are most commonly found in young adults who have been shunted since childhood. Some people have slit ventricles but do not experience any symptoms.
Symptoms include typical signs of shunt malfunction and often are provoked by standing and relieved by lying horizontal, although if they persist for a long time, they may lose this distinctive characteristic. Slit-ventricle syndrome SVS may be diagnosed when people have slit ventricles and experience specific symptoms. A particular symptom of SVS is severe intermittent headaches that are often relieved when lying down.
Imaging studies are required to determine SVS, which is typically indicated by smaller than normal ventricles. Most shunt manufacturers have shunt hardware designed to help decrease slit-ventricle syndromes. Under drainage causes the ventricles to increase in size and can fail to relieve the symptoms of hydrocephalus.
To restore a balanced flow of CSF it may be necessary to place a new shunt with a more appropriate pressure setting. For those who have externally adjustable or programmable valves, the balance of flow may be restored by re-setting the opening pressure.
Symptoms of under drainage include headaches with increasing frequency and severity, which are often worse on waking in the morning. Also, vomiting and dizziness may be signs of under drainage. Adjustment to accommodate patient growth. In children, it may be necessary to modify or revise a shunt in order to adjust for patient growth. For infants implanted at birth, the ventricular catheter may have to be changed around two years to accommodate brain growth. For children, the shunt may need to be revised as the child grows.
For instance, as the child gets taller, the tubing from the head to the peritoneal cavity VP shunt may need to be replaced with a longer tube. However, neurosurgeons try to minimize the need for revisions. For instance, excess length of VP shunt tubing is placed in the peritoneal cavity with the distal catheter. The catheter slowly pulls out of the peritoneal cavity as the child gets taller. For this reason, regular physician follow-up for shunt assessment and maintenance is crucial, particularly in growing children.
Subdural hematoma occurs if blood from broken vessels becomes trapped between the brain and skull. This is most common in older adults with normal pressure hydrocephalus NPH and requires surgery to correct.
Multiloculated hydrocephalus is a loculated isolated CSF compartment in the brain that is enlarged but not connected to the ventricular system. It may be caused by birth trauma, neonatal intraventricular hemorrhage, ventriculitis infection of the ventricle , shunt related infection, over drainage or other conditions. This complication may be difficult to identify because it is typically seen in infants and children who may be neurologically compromised. Surgical treatments include placement of multiple shunts, ventricular catheters with multiple perforations or openings, endoscopic or craniotomy to fenestrate open the intraventricular loculations.
Material degradation. During VP shunt surgery, the doctor placed two small tubes catheters and a valve under your skin. After surgery, your neck or belly may feel tender. You will probably feel tired, but you should not have much pain. For a few weeks after surgery, you may have headaches. It's common to feel some fluid moving around in your scalp.
This will go away as your scalp heals. The area around the stitches or staples may feel tender for a week or more. If needed, the doctor will remove your stitches or staples 5 to 10 days after surgery. The shunt will not limit your activities. There will be a lump on your head where the valve is. This lump may not show when your hair grows back. You may or may not feel the shunt underneath your skin.
In some cases, your doctor may need to adjust your shunt valve so the right amount of fluid is draining. Watch for signs of infection or signs that the shunt is not working right. If the shunt gets infected or stops working well, it may need to be removed or replaced. Without problems, your shunt may be left in place for years.
This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible. Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Call anytime you think you may need emergency care. For example, call if:. Call your doctor or nurse call line now or seek immediate medical care if:. Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if you have any problems. The fluid acts as a delivery system for nutrients that your brain needs, and it also takes away waste products. Normally, CSF flows through these ventricles to the base of the brain.
People of any age can develop hydrocephalus and therefore require a VP shunt. However, according to the Mayo Clinic , hydrocephalus is more likely to occur in babies and older adults. Blockages are the most common cause of hydrocephalus. Cysts, tumors, or inflammation in the brain can impede the normal flow of CSF and create an unsafe accumulation. Symptoms of hydrocephalus can include:.
Imaging tests can confirm the diagnosis of hydrocephalus. Ultrasound , CT scans , and MRI scans allow doctors to view the cavities and tissues within the brain. Testing will show if areas of the brain contain more fluid than normal. Doctors typically perform the placement of a VP shunt while a patient is under general anesthesia.
The entire procedure takes about 90 minutes. Speak to your medical care team about preoperative food and drink restrictions. Older children and adults may need to fast for at least eight hours prior to surgery. Infants and toddlers may only need to stop eating baby formula and solid foods six hours before surgery, but they can usually drink water until four hours before the scheduled procedure. In all cases, these instructions should be reviewed with your surgical team. The surgical nurse will shave the area behind your ear in preparation for shunting, as this is where they will place the catheter.
Catheters are thin, flexible tubes used to drain excess fluid. A surgeon will make a tiny incision behind the ear and will also drill a small hole in the skull. They will then thread one catheter into the brain through this opening.
A physical therapist will work with you before you leave the hospital and help decide if you need help at home, such as special medical equipment or a home care nurse. A caregiver should help you at home for a few days after your surgery while you recover. Before you leave the hospital, look at your incision with your nurse. Knowing what your incision looks like will help you notice any changes later.
On the day of your discharge, you should plan to leave the hospital around am. Before you leave, your doctor will write your discharge order and prescriptions. Your nurse will review these instructions with you before you leave.
A member of your healthcare team will give you more information. People have pain or discomfort for different lengths of time. You may still have some pain when you go home and will probably be taking pain medication. Some people have soreness, tightness, or muscle aches around their incision for 6 months or longer. This happens because some of your nerves were cut during your surgery.
The numbness will go away over time. If you go home with staples or stitches in your incisions, your doctor will take them out during your first appointment after surgery. This is usually 7 to 10 days after your surgery. Do not shower for 5 days after your surgery. After 5 days, take a shower every day to clean your incision.
After you shower, pat the area dry with a clean towel and leave your incision uncovered. For the first 4 to 6 weeks after your surgery:. Doing aerobic exercise, such as walking and stair climbing, will help you gain strength and feel better. Walk at least 2 to 3 times a day for 20 to 30 minutes. You can walk outside or indoors at your local mall or shopping center. Recovery time is different for each person. Increase your activities each day as much as you can.
Always balance activity periods with rest periods. Rest is an important part of your recovery. Ask your doctor when you can drive. Most people can start driving again 4 to 6 weeks after surgery. You can ride in a car as a passenger at any time after you leave the hospital.
Talk with your healthcare provider about your job and when it may be safe for you to start working again. If your job involves lots of movement or heavy lifting, you may need to stay out a little longer than if you sit at a desk. You can travel by bus, train or car. Stop every 2 hours and walk around. This will help keep blood clots from forming in your legs. After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another.
You can also reach them by calling The first step in coping is to talk about how you feel. Family and friends can help. Your healthcare providers can reassure, support, and guide you. Many resources are available to you and your family. MyMSK my. You can use MyMSK to send and receive messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to create their own account so they can see information about your care.
The pressure setting of some VP shunts may accidentally change if you get too close to a magnet. This depends on the VP shunt model. Ask your doctor if you need to take precautions safety measures when coming into contact with magnets. Your doctor will go over these guidelines with you. Your technologist will need to know the model of your shunt and its setting. Your nurse will give you a wallet card with this information. Carry it with you at all times.
You can show your technologist the wallet card. In this case, after your MRI, the pressure setting will need to be checked and may need to be reprogrammed by your doctor or nurse practitioner. In some cases, you may need to have x-rays to find out if the pressure setting has changed. Ask your doctor or nurse if your shunt will need to be reprogrammed after an MRI.
Your shunt should be reprogrammed within 4 hours after your MRI. If you ever need to have abdominal surgery, you must tell your doctor so that precautions can be taken. Tell your doctor if you have peritonitis a condition in which the tissue that covers your abdomen is inflamed or diverticulitis a condition in which small, bulging pouches develop in the intestines or colon and you need emergency surgery or antibiotics.. You can purchase this type of bracelet or necklace at most drug stores.
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