Shunt Patency - CSF

  1. Reason for this procedure
    1. Hydrocephalus is the result of CSF production with the loss of draining through the arachnoid villa. The end result is undue pressure to brain
    2. Once a patient has been diagnosed with hydrocephalus, a shunt is surgically emplace which re-leaves pressure by sending excess CSF to the peritoneal cavity
    3. Failure to relieve the pressure causes: mental retardation, dementia, problems in walking, and inability to control the urinary bladder
    4. If the failed shunt becomes damage, pressure builds within the cranial cavity
    5. Brain damage occurred which usually repairable
  2. Shunt placement
    3. Shunt Placement
    1. The beginning of the shunt is inserted into the ventricle of the brain
    2. Tubing is then run from the cranium to the peritoneal cavity
    3. A valve is placed behind the ear which can be used a pump so fluid can be forced down the tube into the peritoneum, however, usually normal pressure from the CSF will force fluid down the tubing
    4. CSF flows out of the ventricles into the peritoneum re-leaving pressure from the cranial cavity
    5. Extra tubing will be placed in the pediatric population to allow for growth in pediatric patients
  3. Shunt patency is done when malfunction is suspected. This may be caused by
    1. Tubing becomes disconnected
    2. Infection with the inserted tubing
    3. Perforation of an another organ by the tubing in the area of the peritoneum
    4. Obstruction occurring from adhesions caused by the implanted shunt
  4. Protocol

    Case Study - Shunt Blockage

    1. Radiopharmaceutical is injected into the valve
    2. Dose progresses down the tubing, but stops above the stomach
    3. Activity should continue down into the peritoneal cavity
    4. Study indicates blockage in the shunt above the stomach
  5. Case presentation


    6. http://www.numebook.cl/artmes/NM%20Digital%20Book/NeuropsychiatricProcedures_Web/DistalVentriculoperitonealShuntObstruction.htm

    1. This is an example of what might appear to be a normal functioning shunt
    2. Flow is normal from the head and neck
    3. Activity flows down the the tubing, however, activity does not spill into the abdominal cavity
    4. Twenty-four hour images show bladder activity because the radiopharmaceutical that was used is 99mTcO4-. Can you explain the bladder activity?

    http://gamma.wustl.edu/newtfh/general/combined/small_90857U.html

  6. Here is a dynamic flow study showing a working shunt with no obstruction

 

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