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 tubing. Over time, the shunt tubing may also wear out or pull apart and need 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. Call your child's doctor immediately if and when these symptoms develop.
When 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. The doctor will replace the tubing in the head (the proximal tubing), the tubing to the abdominal space (the distal tubing), and / or the valve.
The location of the blockage 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 occurring, so both the head and abdomen need to be explored.
After the Procedure
Your child will go to the Postanesthesia Care Unit (PACU) after surgery, and the surgeon will update you on how well 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).
Before going home, your child must be able to eat and drink without problems, be up walking successfully, have good pain control on oral medicine, and have had a bowel movement.
Before you leave, make sure that a follow-up appointment with the pediatric neurosurgeon is scheduled for approximately 14 days after surgery.
Please refer to any of the following sections if you have concerns once you and your child get home.
Pain. If your child is under 4 years of age, give regular children's Tylenol as directed for pain. Children older than 4 years may go home with a prescription for Oxycodone.
Diet. Once your child is home, they will be on a regular diet. There are some restrictions right after surgery, but since your child will be spending several nights with us, we will restrict the diet as needed during that time.
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 as directed.
Bathing. Clean the wounds daily with a mild soap or shampoo and rinse with clean water (do not use well water or bath 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.
You child will have a follow-up appointment with the neurosurgeon’s office about 14 days after surgery to check the surgical wound check. Further brain imaging (a picture of the size of your child’s ventricles) may be ordered for future comparison weeks after surgery.
If your child becomes ill, this helps determine whether hydrocephalus is the cause of the problem.
Most children return to school or daycare after their sutures are removed, which is done during the follow-up appointment. Watch your child for any signs of hydrocephalus; these would typically be the same symptoms that prompted the surgery. (See Shunt Malfunction for signs of hydrocephalus.)