Saturday, October 4, 2008


Today those diagnosed with hydrocephalus during infancy are given a good prognosis due to an amazing mechanical device called a shunt. Because of the shunt most children will develop relatively normal intelligence and be able to live normal lives. The risks of damage to the central nervous system are reduced by draining the cerbrospinal fluid away from the brain therefore stabilizing the intracranial pressure. Unfortunately, those needing shunts are prone to multiple problems related to shunt dependency and malfunction. As noted by Doctors Drake and Sainte-Rose, shunts are only a temporary solution for a permanent condition.

As quoted by Doctors Drake and Sainte-Rose: "For inherent technical reasons, it is probable that a "shunt forever" is an impossible dream, but delaying shunt malfunction as long as possible is a realistic goal."

Shunt Revision -
When a shunt system needs to be replaced, the operation is referred to as a revision. Which simply mean to change or modify. When a shunt is first put in place, it is the dream of the neurosurgeon and patient that the shunt will last forever. Unfortunately, shunts do not last forever and it is unrealistic to think they ever will. Shunts are susceptible to failures and malfunctions, just like any other mechanical device. Reasons why a shunt may need to be revised:

* Mechanical failures such as the valve has failed to work correctly.
* Use of the wrong type of shunt valve
* Infections* Obstructions* Need to lengthen or replace the distal catheter or valve.

Signs of Possible Shunt Complications -
If a shunt system fails to operate correctly, becomes infected, or obstructed, the patients life and cognitive faculties are placed at risk. Often times the must be revised under emergency conditions. Most signs and symptoms are identical to those at diagnosis. Other symptoms may relate to a particular type of shunt placement.

Shunt Infection -
Shunt infections are the most serious complication related to the treatment of hydrocephalus. They most commonly occur within one to two months following a placement or revision procedure. It is also known that infection represents the most expensive burden of CSF shunt implantation; an average of 8-45 thousands of dollars are needed for each treated patient. The most common germs involved in early shunt infections are Staphylococcus Epidermidis and Staphylococcus Aureus; these bacteria may enter during surgery, from hair follicles and/or sebaceous glands opened by the surgical incision.

Treatment of shunt infections is usually a long process requiring hospitalization. When you have a shunt infection you are placed on high doses of intravenous antibiotics to fight off the infection. The entire shunt system is removed to prevent any possibility of reintroducing the infection to your body. Because the shunt system must be removed, the CSF will be drained through an external ventricle drainage (EVD) system. An EVD consists of a ventricular catheter, a shunt valve, and a bag which collects CSF at the distal end. With the EVD system you will continue to receive intravenous antibiotics until further tests of CSF indicate that the infection is gone. This could take anywhere from two to fourteen days. After the CSF has been proven to be sterile for seven to fourteen days, your neurosurgeon will insert a new shunt system.

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