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Shunt Procedure
In this procedure, a ventricular catheter is placed in the cerebral ventricles. This allows the bypass and drainage of the excess fluid to other cavities in the body. The fluid may be drained into cavities such as the peritoneal cavity, the right atrium, pleural cavity and gallbladder. A shunt is a tube that is soft and flexible, and is usually made up of plastic or silicone rubber. It contains a valve that allows drainage and a catheter that joins the drainage and deposit sites. A small sensor may be placed near the valve to check pressure levels if the intracranial pressure is high. A ventriculoperitoneal shunt is permanently placed with one end inserted in a ventricle of the brain and another end in the peritoneal cavity. Other drainage sites may be the gall bladder, the heart’s right ventricle and the pleural area surrounding the lungs. According to the location of obstruction, fluid drainage may be done from the subarachnoid space around the brain. The shunt is usually replaced after 10 years in adults. In children, the shunts may need to be replaced sooner.
How to prepare for a Shunt proecdure?
- Hydrocephalus should be diagnosed correctly by a CT scan or MRI.
- Cerebrospinal fluid should be tested if any infection or tumor is suspected.
- Patients with mental disabilities should go through neuropsychological examination.
- The patient should inform the doctor about any medical conditions and illnesses.
- Some medication that the patient is taking may be stopped.
Duration of procedure/surgery : Approximately one and a half hours
Days admitted : 3 to 4 days
Anesthesia : General anesthesia
Recovery : - The patient is required to lie flat for 24 hours if the shunt is placed for the first time.
- The patient’s neurological status and vital signs are monitored
- Pain medication may be prescribed by the doctor.
- The shunt is checked to ensure it is functioning normally.
Risks : The risks involved in ventricular shunt procedure include the following:
- Problems in the abdomen such as collection of excess fluid
- Blockage in the shunt
- Clotting
- Loss of memory and sensations
- Seizures
- Paralyses
- Headaches
- Speech problems
- Valve failure
- Bleeding
- Reaction to anesthesia
After care : - The surgery area should be kept clean to avoid infections.
- The cerebrospinal fluids should be checked by the doctor periodically to ensure that there is no infection and bleeding.
- The pressure of the cerebrospinal fluid should be checked.
- The patient’s eyes should be checked regularly for any symptoms of optic nerve damage that a shunt failure may cause.
The doctor should be contacted immediately if the following symptoms occur:
- Fever
- Breathing difficulty
- Eating problems
- Seizures
- Stiff neck
- Severe headaches
- Severe drowsiness
- Vomiting
- No pulse
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Spinal Tap
Spinal tap is also referred to as lumbar puncture. In this procedure a thin needle is inserted between the bones in the lower spine region to remove the cerebrospinal fluid. Once the fluid is collected, the needle is removed and the area is bandaged. The collected fluid may be sent for lab testing.
How to Prepare for Spinal Tap
- The patient may need to give some blood tests.
- The patient should inform the doctor about any medical conditions and illnesses and medication that the patient may be taking.
- Some medication that the patient is taking may be stopped
Duration of procedure/surgery : Approximately 30 minutes.
Days admitted : None. Spinal tap is performed as an outpatient procedure.
Anesthesia : Spinal anesthesia.
Recovery : - The patient is required to lie flat on the back for some while to reduce the chances of headaches.
- The puncture area may be painful for 1 to 2 days.
Risks : The risks associated with spinal tap are minimal. They include the following:
- Infection
- Bleeding
- Headache
- Herniation
- Epidermoid cyst
After care : - The puncture site should be monitored for any sign of infection.
The doctor should be contacted if the following symptoms occur:
- Infection symptoms that include swelling, redness, pus formation and tenderness.
- Headache
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Third Ventriculostomy
This procedure is used only on patients with hydrocephalus induced by a blockage of the cerebrospinal fluid. It makes a bypass for the cerebrospinal fluid in the brain, and a shunt is not required. In this procedure, an endoscope is passed through the top of the skull into the brain. The endoscope enters the third ventricle through the lateral ventricle. A hole is made in its floor using a laser and excess fluid is drained into the subarachnoid space through the hole.
How to Prepare for Third Ventriculostomy
- The patient may need to give some blood tests.
- The patient should inform the doctor about any medical conditions and illnesses and medication that the patient may be taking.
- Some medication that the patient is taking may be stopped.
Days admitted : 2 to 3 days
Anesthesia : General anesthesia
Recovery : - The patient is taken to the Post-anesthesia Care Unit (PACU).
- Once the patient starts to eat, drink and move around normally after some days, the patient will be discharged.
- Before a follow-up appointment with the doctor, the patient is required to do a cine MRI. This is done to confirm the opening that is made in the base of the third ventricle, and to determine if the hydrocephalus treatment is effective.
Risks : The risks associated with third ventriculostomy are very rare. They include the following:
- Over drainage
- Injury to the basal artery
- Hemorrhage
After care : The doctor should be contacted if the following symptoms occur:
- Fever
- Severe headache
- Excess vomiting
- Severe drowsiness
- Infection at the incision area