Ventriculo-Peritoneal Shunts Infections

Posted by e-Medical PPT Thursday, September 16, 2010
Ventriculo-Peritoneal Shunts are commonly used to treat hydrocephalus, the swelling of the brain due to excess buildup of cerebrospinal fluid.If left unchecked, the cerebral spinal fluid can build up leading to an increase in intracranial pressure which can lead to intracranial hematoma, cerebral edema, brain herniation. The Ventriculo-Peritoneal Shunts can be used to alleviate or prevent these problems in patients who suffer from hydrocephalus or other related diseases. Shunts can come in a variety of forms but all of them consist of a pump or drain connected to a long catheter, the end of which is usually placed in the peritoneal cavity.
There are a number of complications associated with shunt placement. Many of these complications occur during childhood and cease once the patient has reached adulthood. Many of the complications seen in patients require immediate shunt revision.The common symptoms often resemble the new onset of hydrocephalus such as headaches, nausea, vomiting, double-vision, and an alteration of consciousness.Furthermore the shunt failure rate 2 years after implantation has been estimated to be as high as 50%.
Shunt infection is a common problem and can occur in up to 27% of patients with a shunt. Infection can lead to long term cognitive defects, neurological problems and in some cases death. Common microbial agents for shunt infection include Staphylococcus epidermidis, Staphylococcus aureus, and Candida albicans.
Another leading cause of shunt failure is the blockage of the shunt at either the proximal or distal end. At the proximal end the shunt valve can become blocked due to the buildup of excess protein in the CSF.The shunt can also become blocked at the distal end if the shunt is pulled out of the abdominal cavity,or from similar protein buildup. Other causes of blockage are overdrainage and slit ventricle syndrome.
Over drainage occurs when a shunt has not been adequately designed for the particular patient. Overdrainage can lead to a number of different complications.Recent studies have shown that over drainage of CSF due to shunting can lead to acquired Chiari I Malformation.
Slit ventricle syndrome is an uncommon disorder associated with shunted patients, but results in a large number of shunt revisions. The condition usually occurs several years after shunt implantation. The condition is often thought to occur during a period where overdrainage and brain growth occur simultaneously. In this case the brain fills the intraventricular space leaving the ventricles collapsed.

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