Shunts

A shunt is a tube that drains the cerebrospinal fluid (CSF) from the ventricles in the brain to another space in the body, which reabsorbs the fluid. Most often the abdominal cavity (the space around the stomach and intestines) is used. The shunt's small, soft tubing is placed, or tunneled, under the skin, and the end of the tubing is placed in the abdominal space. This is done in the operating room.

A valve is attached to the shunt tubing. It controls the direction the cerebrospinal fluid flows and keeps a normal amount of cerebrospinal fluid in the ventricles. The valve adjusts the amount of cerebrospinal fluid that flows from the ventricles and prevents the ventricles from over-draining, which is called over-shunting. 

A shunt malfunctions when something blocks the flow of cerebrospinal fluid within the shunt. This may be caused by the buildup of the tissue, proteins and chemicals in the cerebrospinal fluid that clog the tubing. It may also be caused by tissue within the abdominal space that blocks the flow of the distal tubing. Additionally, over time the shunt tubing may wear out or pull apart, requiring it to be replaced.

The signs of a shunt malfunction are similar to the signs of hydrocephalus. The symptoms are a result of pressure again building up within the head. Notify your child's doctor immediately if these symptoms develop.

shunts-diagramWhen a shunt is not working well, all or part of it must be replaced. This is done in the operating room. Your child's neurosurgeon will decide where the problem is within the shunt system. He / she will then replace the tubing in the head (the proximal tubing), the tubing to the abdominal space (the distal tubing), and / or the valve.

Where the blockage is, proximal or distal, will determine where the surgeon needs to operate. If it is a blockage in the proximal system (valve or ventricular catheter), a small patch of hair will be shaved and a “C” shaped incision will be made.

If the blockage is a distal malfunction, there will be an abdominal incision. Sometimes it is unclear where the malfunction is; both the head and abdomen need to be explored.

After surgery, your child will go to the Post Anesthesia Care Unit (PACU) and the surgeon will update you on how the surgery went. When you receive a call from the PACU, you may join your child.  

Your child will spend one to three nights with us, and we will take care of special dietary needs (general anesthesia may cause an upset stomach). When your child is eating and drinking well, has been up walking around successfully and has his or her pain under control, he or she will be discharged home.  

Our discharge criteria are that the child is able to take good oral nutrition, have good pain control on oral meds and has had a bowel movement. 

Before you leave, make sure that a follow-up appointment with the pediatric neurosurgeon is scheduled approximately 14 days after surgery. 

Refer to the following if you have concerns once you and your child get home: 

  • Pain. If your child is under 4 years of age, administer regular children's Tylenol as directed. Children older than 4 may be sent home with a prescription for Tylenol with Codeine. 
  • Diet. Once your child is home, he or she will be on a regular diet. There are some restrictions immediately following surgery, but since your child will be spending several nights with us, we will restrict the diet as needed. 
  • Wound care. You should wash your child's incision each day with a mild shampoo.   
  • Activity. Your child may resume regular activities gradually upon returning home. 
  • Medication. No medications are prescribed routinely following hydrocephalus surgery. If your child complains of pain at the site of the incision, give Tylenol. 
  • Bathing. The wounds should be washed daily with a mild soap or shampoo and rinsed with clear water. A shower is fine if your child typically takes showers. Do not let the wound soak in water such as a bathtub or swimming pool until the skin is completely healed.  

Approximately 14 days after surgery your child will have a follow-up appointment with the Neurosurgery Division for a wound check. Further brain imaging, a picture of the size of your child’s ventricles, may be ordered for comparison. If your child becomes ill, this helps in determining whether hydrocephalus is causing problems. 

Your child may return to school or daycare three to five days after surgery, depending on how he or she feels. Observe your child for signs of hydrocephalus; these would typically be the same symptoms that prompted the surgery. (See shunt malfunction for signs of hydrocephalus.)


Last Updated 12/2012