Ventricular Shunts for Hydrocephalus

Abstract

Hydrocephalus is defined as a distention of the ventricular system of the brain that is the result of inadequate flow of cerebrospinal fluid from the location where it is produced within the ventricles to its site of absorption into systemic circulation. The prevalence of hydrocephalus has increased in the general population due to advances in neurosurgery and increased survival of critically ill infants. The diagnosis of hydrocephalus is based on clinical and radiographic data. The initial treatment is placement of a shunt between the cerebral ventricle to the abdomen, heart, or pleura. Alternatively an endoscopic third ventriculostomy with or without choroid plexus cauterization, which bypasses the obstruction can be performed. Children and adults with shunts will typically have at least one shunt failure during their lifetime and these are evaluated on the basis of clinical symptoms and imaging. Most failures occur with the ventricular catheter, but failures also occur from fractured hardware and blockages anywhere along the shunt tract. General surgeons are involved in the management of abdominal infections, when lysis of adhesions is needed to create an intraperitoneal space for the catheter or if access to the pleural space or central venous system is needed.