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

Stay updated, free articles. Join our Telegram channel

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