21 Ventriculopleural Shunt

10.1055/b-0040-176510

21 Ventriculopleural Shunt

Ryan F. Amidon, Christ Ordookhanian, and Paul E. Kaloostian

21.1 Symptoms and Signs

  • Gait disturbance

  • Difficulty maintaining balance and walking

  • Mild dementia

  • Impaired bladder control

  • Headache

  • Fatigue

  • Nausea

  • Irritability

  • Confusion

  • Large head size

  • Seizures

  • Impaired vision

  • Abnormal sleeping behavior

  • Memory loss

21.2 Surgical Pathology

  • Cranial benign/malignant trauma

  • Cranial benign/malignant infection

  • Cranial benign/malignant tumor

  • Cranial benign/malignant surgical complication

21.3 Diagnostic Modalities

  • Patient history

  • Physical examination

  • Neurological examination

  • CT of brain (detect enlarged ventricles)

  • MRI of brain (detect enlarged ventricles)

  • Ultrasound of brain

  • Cerebrospinal fluid (CSF) testing (predict shunt responsiveness, determine shunt pressure)

    • Lumbar or spinal tap

    • External lumbar drainage

    • Measure CSF outflow resistance

21.4 Differential Diagnosis

  • Communicating hydrocephalus: CSF can still flow between ventricles, but gets blocked after exiting

    • Resulting from subarachnoid hemorrhage, head trauma, infection, tumor, or surgical complication

    • Normal pressure hydrocephalus (NPH)

  • Noncommunicating hydrocephalus (obstructive hydrocephalus): CSF flow blocked along passage(s) connecting ventricles

  • Congenital hydrocephalus vs. acquired hydrocephalus

  • Hydrocephalus ex-vacuo: Occurs when stroke, degenerative diseases, or head trauma damages brain (brain tissue shrinkage may occur)

21.5 Treatment Options

21.5.1 Surgery if Deemed Suitable Candidate

  • Determine overall prognosis and Karnofsky performance score

  • If poor surgical candidate with poor life expectancy, medical management recommended

  • Endoscopic third ventriculostomy (neuroendoscope visualizes ventricular surface and a hole is created in floor of third ventricle, allowing CSF to bypass obstruction and flow toward sites of resorption)

  • Shunting (relieving fluid buildup responsible for hydrocephalus)

    • Types:

      • Ventriculoperitoneal (VP): Ventricular inflow, peritoneal cavity (abdomen) outflow

      • Lumboperitoneal (LP): Lumbar spine inflow, peritoneal cavity (abdomen) outflow

      • Ventriculopleural (VPL): Ventricular inflow, pleural cavity (lung) outflow

      • Ventriculoatrial (VA): Ventricular inflow, right atrium of heart outflow

    • Components:

      • Inflow/Proximal catheter (drains CSF from ventricles or subarachnoid space)

      • Valve mechanism (regulates differential pressure or controls flow through shunt tubing, connected to proximal catheter)

      • Outflow/Distal catheter (directs CSF from valve to abdominal or peritoneal cavity, heart, or other drainage site)

Only gold members can continue reading. Log In or Register to continue

Related posts:

19 Ventriculoperitoneal Shunt 20 Lumboperitoneal Shunt 22 Ventriculoatrial Shunt 6 Spinal Radiosurgery 11 Hemicraniectomy (Unilateral, Bilateral, Bifrontal versus Frontotemporal) 15 Subdural Grid Placement

Stay updated, free articles. Join our Telegram channel
Tags: , ,
May 15, 2020 | Posted by in NEUROSURGERY | Comments Off on 21 Ventriculopleural Shunt

Full access? Get Clinical Tree
Get Clinical Tree app for offline access