Ventriculoperitoneal shunt obstruction

Background
  • Most common type of shunt malfunction
    • Usually occurs at proximal tubing, followed by distal tubing followed by valve chamber
  • Proximal obstructions usually occurs within first years of insertion
  • Distal obstruction usually occurs only with shunts in place for >2yr
  • 60% of children suffer malfunction within lifetime

Causes
  • Proximal obstruction
    • Tissue debris
    • Choroid plexus
    • Clot
    • Infection
    • Catheter-tip migration
    • Localized immune response to the tubing
  • Distal obstruction
    • Kinking or disconnection of the tube
    • Pseudocyst formation
    • Infection

Clinical Features
  • Infants with bulging fontanelles and suture diastasis
  • Irritability
  • Change in level of consciousness
  • Nausea/vomiting, poor feeding
  • Seizure
  • Cushing's triad

Differential Diagnosis

Ventriculoperitoneal shunt problems

Evaluation
  • Shunt series
  • CT scan without contrast
  • Ventricular tap
  • MRI, unless patient has programmable shunt (Can be recalibrated by Neurosurgery if needed)
  • Pumping shunt (institution dependent) - may pull choroid plexus into shunt or cause intraparenchymal bleed

Management
  • Rapid deterioration and NSGY capability distant, may require shunt tap until pressure < 15 mmHg
  • If pressure not relieved by shunt tap, obstruction likely proximal

See Also

References
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