The most common treatment for hydrocephalus is the surgical insertion of a drainage system, called a shunt. It consists of a long, flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate. One end of the tubing is usually placed in one of the brain's ventricles. One end of the tubing is usually placed in one of the brain's ventricles. The tubing is then tunneled under the skin to another part of the body where the excess cerebrospinal fluid can be more easily absorbed such as the abdomen or a chamber in the heart.
People who have hydrocephalus usually need a shunt system for the rest of their lives, and regular monitoring is required.
A shunt provides an alternative fluid pathway through which CSF bypasses an obstruction(s) in the fluid compartments of the brain, and acts when CSF absorption is otherwise impaired. Such a bypass relieves the excess fluid buildup that is responsible for hydrocephalus. When CSF production and absorption are in balance, hydrocephalus is considered “compensated”; when out of balance, complications associated with elevated pressure or over drainage occur causing the signs of a malfunctioning shunt.
The surgical nurse will shave the area behind your ear in preparation for shunting, as this is where they will place the catheter. Catheters are thin, flexible tubes used to drain excess fluid. A surgeon will make a tiny incision behind the ear and will also drill a small hole in the skull. They will then thread one catheter into the brain through this opening. The other catheter goes behind your ear and is subcutaneous, meaning it resides under the skin. This tube travels down to your chest and abdomen, allowing excess CSF to drain into the abdominal cavity, where your body absorbs it. Your surgeon may attach a tiny pump to both catheters and place it under the skin behind your ear. The pump will automatically activate to remove fluid when the pressure in the skull increases. It may even be possible to program the pump, also called a valve, to activate when the fluid increases to a certain volume.
Placement of a shunt is a very safe procedure. However, complications can occur during or after the procedure. Unlike most surgical procedures, in which the risks are highest during the operation itself, most of the common problems associated with shunting can and do occur at a later time. The most common complications with shunting are obstruction, infection, and over drainage of cerebrospinal fluid.
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The actual surgical procedure to implant a shunt typically requires about an hour in the operating room. Afterward, you will be carefully observed for 24 hours. Your stay in the hospital will generally be for two to four days total.
While you’re in the PACU, your pain will be managed with medications, You may have a mild headache or feel discomfort around your incision for the first few days after your surgery.
At first, you will get pain medication in your IV line. Once you’re able to eat normal food, you will get oral pain medication (medication you swallow).
Your doctor and nurse will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell your doctor or nurse. It’s important to control your pain so you can use your incentive spirometer and move around. Controlling your pain will help you recover better.
You will be given a prescription for pain medication before you leave the hospital. Talk with your doctor or nurse about possible side effects and when you should start switching to over-the-counter pain medications.
Many people with normal pressure hydrocephalus enjoy a normal life with the help of a shunt. Regular, ongoing checkups with the neurosurgeon will help ensure that your shunt is working correctly, your progress is on track, and you are free to keep living the way you want.
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The average lifespan of an infant's shunt is two years. Adults and children over the age of 2 may not need a shunt replacement for eight or more years.
Programmable shunt valves can be affected by strong magnets, possibly changing the pressure setting of the shunt. Metal detectors, security scanners at airports and shops, microwave ovens and mobile phones will not affect the valve. Flying in a regular commercial jet is fine for most people with shunts, If you were told years ago not to fly, it's worth asking your neurosurgeon again as things have changed.
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