ventriculoparietal shunt

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CEREBRAL SHUNTSCEREBRAL SHUNTS

DR DIPTI PATIL (1DR DIPTI PATIL (1 STST MDS)MDS)DEPT OF ORAL MAXILLOFACIALDEPT OF ORAL MAXILLOFACIAL

SURGERYSURGERY

KCDS,BANGLORE.KCDS,BANGLORE.


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CONTENT Introduction Anatomy Indications Technique

Complications


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Cerebral shunts are used to drain excesscerebrospinal fluid build up in brain after condition like hydrocephalus.

Or else it can lead to-intracranial pressure (ICP)-intracranial hematoma,-cerebral edema,-crushed brain tissue or -herniation.


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Distal end of the location of the catheter is locatedin any tissue with enough epithelial cells to absorbthe incoming CSF.

Based on the catheter distal end location.

route Location of the drain

Ventriculo-peritoneal shunt(VP shunt

Peritoneal cavity

Ventriculo-atrial shunt (VAshunt)

Right atrium of the heart

Ventriculo-pleural shunt (VPL

shunt)

Pleural cavity

Lumbar-peritoneal shunt (LPshunt)

Peritoneal cavity

Gall bladder & ureter is also suiatable location.


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Cerebrospinal fluid Its modified tissue fluid contained in theventricular system of the brain &subarachnoid space around the brain &spinal cord.

CSF replaces lymph in CNS.


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Its formed by choroid plexus of the lateral ventricles,& lesser amount by 3 rd & 4 th ventricle with rate of 200ml/hour.

Total amount of CSF is 150 ml. Normal pressure of CSF is 60-100 mm of water.


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Circulation &absorption of

CSF

Lateral ventricles

Intra ventricular foraminaMonroe foramina

3rd ventricles

Cerebral aqueduct of midbrain

4th ventricles

Lateral ventricles

Cerebellomedullary cistern& pontine cistern

Tentorial notch

Inferior surface of cerebrum

Superolateral surface of cerebrum

Arachoid granulations

Superior sagittal sinus

Central canal of spinal cord

Subarachnoid space aroundspinal cord &cauda equina

Veins of spinal cord


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Function of CSF

Decreases the sudden pressure or forces on thedelicate nervous system.

Provide nourishment & returns the metabolic

product to venous system. Constantly provide glucose & oxygen to the brain. Pineal gland secretions reach the pituitary glandvia CSF.

Cushions the brain within the solid vault. Drugs can reach the brain through the CSF Act as lymph in the CNS .


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Hydrocephalus

defined by as a disproportionateincrease in the amount of CSFwithin cranium, usually inassociation with a rise in ICPthat result from impairedcirculation and absorption of CSF, or in rare circumstancesfrom increased productionby a choriod plexus papilloma.


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Obstructive or non-communicating (obstructionwithin the ventricular system)

Non obstructive or communicating (malfunctionof arachnoid villi)


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Obstructive of non communicatinghydrocephalus

Aqueductal stenosis . Aqueductal gliosis. Intrauterine viral infections

Lesions or malformations of posterior fossa-Dandy-Walker syndrome

Vein of Galen malformation

Meningitis-Pneumococcal,-TB


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Non obstructive or communicating

hydrocephalus

Most commonly follows a subarachnoid

hemorrhage. Pneumococcal and tuberculous meningitis Leukemic infiltrates.


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Clinical manifestations

S igns: Anterior fontanel wide open

and bulging, increased head

circ. Dilated scalp veins Brisk tendon reflexes,

spasticity Macewen sign cracked

pot Prominent occiput (dandy-

walker)


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Surgical Treatment

Cerebral shunts


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Ventriculo-peritonial shunt

A surgical procedure toinsert a communicatingcatheter to relieve

intracranial pressure causedby hydrocephalus.

In this procedure thecerebrospinal fluid isshunted from the ventriclesof the brain into theperitoneal cavity via asurgically implanted tube..


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Burhole placed & catheter insertedinto the ventricle

U shaped incision placed behindthe ear & 2 nd catheter placed under the skin behind the ear and moveddown the neck and chest, andusually into the abdominal(peritoneal) cavity.

A valve (fluid pump) is placedunderneath the skin behind the ear which attached to both catheters.

When extra pressure builds uparound the brain, the valve opens,and excess fluid drains out of it intoperitonium.

This helps decrease intracranialpressure.


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Ventriculo-pleural shuntSurgical procedure for

diverting cerebrospinalfluid from engorgedventricles inhydrocephalus, usually inthe newborn.

In this procedure,cerebrospinal fluid isdiverted from the lateralventricle into the pleural

cavity.


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Ventricular-atrial shunt

This is a device which drainsthe extra fluid in the brain

into the right atrium of theheart. A shunt catheter is placedinto a interal jugular vein

and threaded down wherethe vein joins a larger veincalled the Superior VenaCava.


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After ventriculostomy, internal jugular veinpuncture was performed by a 21 Gauge introducer needle, followed by the introduction of a 0.35 mmguide wire.

A peel-away was inserted along the guide. Wirelength up to the atrium was verified under x-rays,

then the wire was removed and a premeasuredshunt segment was freehand guided through thepeel-away up to the atrium.

Contrast was injected through the catheter toconfirm final position

Finally, the system connected to valve.


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Lumbar-peritonealshunt The Lumbar-peritonealshunt is inserted between

two of the vertebrae in thelumbar region of the spine

into the Subarachnoidspace through lumbar puncture.

shunt is passed under the

skin and continues aroundthe oblique muscles onone side of the body, andterminates at

the peritoneal cavity.


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complication

Infection Contusion or bleeding in the brain. Brain swelling.

Skin erosion. The shunt may become infected. Shunt obstruction.

Abdominal infection. Over drainage. Plural effusion. Pulmonary hypertension.


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