Shunt surgery

Background

Shunt surgery is performed to treat disturbances in the circulation of cerebrospinal fluid (hydrocephalus, fluid on the brain). The pro-cedure involves placing a shunt system (thin silastic tubing and a small valve device) under the skin on the head. The tubing runs from the head to the neck or abdomen, channelling excess fluid from the cerebral ventricles to either the abdominal cavity or absorbed in blood circulation.

Disturbances in the circulation of cerebrospinal fluid

Disturbances in the circulation of cerebrospinal fluid can present in patients of all ages and for many different reasons. Symptoms vary according to the cause of the disturbance. If the disturbance is being caused by, for example, a tumour, the most common course of action is the surgical removal of the tumour, which also corrects the hydrocephalus without requiring shunt surgery.

Common causes of disturbances in the circulation of cerebrospinal fluid that require shunt surgery in adult patients include intracranial haemorrhaging or complications resulting from head trauma. The most common reason for performing shunt surgery is, however, Normal Pressure Hydrocephalus (NPH), whose cause is usually unknown. Typically, NPH causes symptoms such as difficulty walking as well as memory impairment and urinary incontinence.

In patients over 60 years of age, NPH is a slowly progressing disorder which can only be treated by means of shunt surgery. Unfo-rtunately, NPH diagnoses can never be fully confirmed prior to shunt surgery, which is why some patients may go without the expected and desired treatment of their symptoms. Shunt surgery

Shunt surgery is performed by a neurosugeon, who decides which type of shunt to use (ventriculo- peritoneal or ventriculo-atrial). The procedure is performed under general anaesthesia and usually takes less than an hour. In most cases, the procedure involves making two or three small incisions on the head and neck or abdomen. The shunt is inserted through these incisions.

Because the shunt being placed inside the body is a foreign object, all possible inflammatory and bacterial colonies are treated. When arriving for surgery, the skin must be as clean as possible, with no wounds or lesions. The patient’s oral and dental condition must also be examined prior to the shunt surgery. This ’pre-treatment’ reduces the risk of bacterial infection.

Post-operative pain is generally managed with ordinary strength pain medication. The hospital stay is, in most cases, 3-5 days.

Effects of shunt surgery

The benefits of shunt surgery and loss of symptoms may be experienced right away while still in hospital, but in some cases the patient’s condition will take a few weeks to improve. A follow-up examination (approximately 2 months after surgery) will be conducted at the clinic to evaluate the outcome of the treatment. In almost all cases, the shunt is a permanent treatment that allows the patient to live as normal a life as possible.

After shunt surgery/placement, different shunt complications may occur. The most common of these are shunt blockage, inflammation or over-draining. Some patients will therefore require corrective surgery (shunt revision).

In some cases, shunt surgery can be replaced by an Endoscopic third ventriulotomy (ETV).