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Complications of CSF Shunting in Hydrocephalus pp 13–32Cite as

Clinical Manifestations of CSF Shunt Complications

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Abstract

Hydrocephalus and hydrocephalus-related problems occupy a large part of current neurosurgical activity, accounting for approximately 35–50 % of pediatric neurosurgical practice. At present, the most frequent treatment for hydrocephalus consists of cerebrospinal fluid (CSF) shunting, especially with ventriculoperitoneal (VP) shunts. Other types of CSF derivations, such as lumboperitoneal, ventriculopleural, ventriculo-gallbladder, subgaleal shunting, etc., continue to be in use, although they are less often utilized. Ventriculoatrial valves have almost totally been abandoned due to the severity of their complications. On the contrary, neuroendoscopic procedures, especially endoscopic third ventriculostomy (ETV), are increasingly being used in daily practice for avoiding shunt complications.

Shunt-related complications are numerous and difficult both to manage and to avoid. Shunt failure occurs in a proportion as high as 45–50 % during the first year after surgery and has a subsequent estimated incidence of 4–5 % yearly. At the time of placing a CSF shunt, the neurosurgeon must carefully plan the operation or shunt revision, bearing in mind not only the immediate success of the operation but also taking into account the avoidance of possible future complications.

In this chapter, common clinical manifestations of shunt failure are dealt with, considering the (1) type of complication (mechanical, functional, or infectious), (2) patient’s age at shunt insertion, (3) etiology of the hydrocephalus, (4) early or late appearance of complications, and (5) place of CSF drainage (peritoneum, pleura, jugular vein, etc.).

Standard adjuvant clinical methods for diagnosis of the site and type of complication will be briefly discussed, aimed at planning the most appropriate approach for a shunt revision and at trying to avoid unnecessary surgery. A better knowledge of complications related to shunting and of preventive measures seems to be crucial for increasing technique safety and for improving patients’ outcomes.

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Authors and Affiliations

  1. Pediatric Neurosurgery Section and Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, 30120, El Palmar, Murcia, Spain

    Juan F. Martínez-Lage MD, Antonio L. López-Guerrero MD & María-José Almagro MD

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  1. Juan F. Martínez-Lage MD
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Correspondence to Juan F. Martínez-Lage MD .

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Editors and Affiliations

  1. Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy

    Concezio Di Rocco

  2. Department of Neurosurgery, Adnan Menderes University School of Medi, Aydin, Turkey

    Mehmet Turgut

  3. Division of Pediatric Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA

    George Jallo

  4. Regional Service of Neurosurgery and Unit of Pediatric Neurosurgery, Virgen de la Arrixaca University Hospital, Murcia, Spain

    Juan F. Martínez-Lage

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Martínez-Lage, J.F., López-Guerrero, A.L., Almagro, MJ. (2015). Clinical Manifestations of CSF Shunt Complications. In: Di Rocco, C., Turgut, M., Jallo, G., Martínez-Lage, J. (eds) Complications of CSF Shunting in Hydrocephalus. Springer, Cham. https://doi.org/10.1007/978-3-319-09961-3_2

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