Ventriculoperitoneal shunt is the most important method for treating hydrocephalus, which is often not well understood by patients or their families.
1.How ventriculoperitoneal shunt is performed.
The drainage tube at the ventricular end is inserted into the ventricle through a hole in the skull, and the drainage tube is connected to a shunt valve (to control the outflow rate of cerebrospinal fluid), and then connected to a drainage tube at the ventral end, which is placed into the abdominal cavity through a subcutaneous tunnel, so that cerebrospinal fluid can enter the abdominal cavity through the drainage tube from the ventricle and be absorbed by the abdominal cavity.
The left side shows the shunt system, and the right side shows the postoperative radiographs
2. Main risks of surgery.
Infection: Since the drainage tube is a foreign body, unlike living tissue which has blood and flesh, it does not have the ability to resist infection. Therefore, the greatest concern is infection, which can cause ventricular inflammation once infected, which is costly and can be life-threatening, and often requires the drainage tube to be removed to control ventriculitis.
Bleeding from the puncture tract: The ventricular drainage tube is used to puncture the brain tissue into the ventricle, and bleeding from the puncture tract can occur, but the incidence is not high.
Blockage of drains: Due to chronic inflammation or high protein content of cerebrospinal fluid, blockage of drains can occur and the original hydrocephalus symptoms appear again. This requires prompt medical attention and management by a physician to address the blockage and replace the drainage tube if necessary.
Despite the common risks mentioned above, the overall incidence is not high, and those who need to perform shunts should do so promptly, as the benefits outweigh the risks!
Otherwise, if the shunt is delayed, hydrocephalus will continue to develop, leading to irreversible damage to brain tissue, and further surgery will not restore the lost brain function!
There are often clinical patients’ families who delay surgery due to early fear of surgical risks, resulting in irreparable damage and regret!
3.Why is it necessary to place a drainage tube? Is the drainage tube placed in the body for life? How long can the drainage tube last?
The water in the ventricles is dynamic “living water”, constantly produced and absorbed, so it cannot be solved by pumping, and the drainage tube placed cannot be taken out again after a period of time. If the drainage tube becomes blocked or does not work, the cause of the blockage needs to be identified and resolved, and the drainage tube needs to be replaced if necessary. How long a drain will work depends on the patient, and most can last more than a decade or longer.
In children, as they grow taller, they should promptly go to the hospital to assess the need for replacement of the abdominal end drains.
4.Cautions after drainage tube surgery
The drainage tube is buried under the skin and has no effect on general daily activities. Be careful not to cause trauma to the area through which the drainage tube passes, so as not to expose or break the drainage tube, leading to reoperation or infection, etc. You can take a bath one week after the surgical wound is removed, and you should wash it with warm soapy water or body wash, but do not rub it hard.
5.Why use adjustable pressure drainage tube as much as possible?
Normal intracerebroventricular fluid pressure is not constant, it can self-regulate and fluctuate within a certain pressure range in order to maximize the protection of brain tissue. The brain tissue is located between the intracerebroventricular water and the skull, and too much pressure in the intracerebroventricular water will compress the brain tissue; conversely, too little intracerebroventricular pressure will not support the role of the brain tissue and will be detrimental to the brain tissue.
Therefore, the brain pressure needs to adapt to the physiological dynamics of the human body. After hydrocephalus occurs, the ability to regulate brain pressure is impaired, so it needs to be replaced by a drainage tube system that can regulate pressure. For example, we have several speeds of electric fans at home, and when it is hot, we need to turn on the high speed, and when it cools down, we need to turn down the low speed. Adjustable pressure drainage tube can be outside the skin through the instrument to adjust the shunt gear (most through the magnet principle of adjustment), is no damage.
6.How can I tell if the shunt level of my adjustable drainage tube is appropriate?
The key is the size of the ventricle as shown by CT or MRI and the patient’s self-perception. The patient’s self-perception is the most important!
Insufficient shunt performance (insufficient intraventricular fluid drainage): the patient’s original symptoms do not improve, there is nausea, headache, dizziness, vomiting, double vision, unstable walking, etc. The patient’s symptoms worsen after lying down and decrease after standing up for a period of time. If the patient’s home is far from the hospital and he cannot go to the hospital immediately, he can press the shunt valve to temporarily accelerate the discharge of cerebrospinal fluid and relieve the symptoms, and then go to the hospital for examination and treatment in time.
Excessive shunt manifestation (excessive intracerebroventricular fluid drainage): The patient’s symptoms are relieved after lying down and aggravated after standing up and moving around for a period of time.
7.When do I need to go to the hospital for review after surgery?
If the original symptoms do not improve, or if there is nausea, headache, dizziness, vomiting, double vision, unstable walking, etc., you should go to the hospital for a review in time!
Even if there is no discomfort after surgery, you should go to the hospital to review the cranial CT in one month after surgery to understand the situation in the brain.
If you have any questions, please come to my clinic for consultation, or through this website, but do not make inquiries in the comments below, because the content of the comments can not promptly alert to me.