Pediatric emergency medicine trisk 4647 4647
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Different types of CSF shunts vary mostly by the location of the distal tubing and
the type of reservoir or valve system. The choice of CSF shunt type and the
method of placement (endoscopically or nonendoscopically) depend on the
individual patient’s anatomy and cause of hydrocephalus and the experiences and
preferences of the neurosurgeon performing the procedure. Commonly, the
patient or caregiver knows the location and type of shunt and is able to provide
details regarding prior shunt placement and problems. Palpation of the hardware
and plain radiographs may be used to acquire more information regarding the
specific location of the shunt components. Most CSF shunts have the following
components: (1) proximal shunt tubing, (2) reservoir system, and (3) distal shunt
tubing ( Fig. 135.3 ). Occasionally, the system will not contain a reservoir and
instead will have a one-way valve.
The proximal shunt tubing has a fenestrated tip that is usually located in the
ventricle but may also be located inside a communicating cyst or in the lumbar
subarachnoid space. This tip allows free passage of CSF into the shunt system
unless it becomes occluded. More than one proximal catheter may be present if
multiple, noncommunicating areas of the brain require shunting. The reservoir
system consists of one or two “domes” or “bubbles.” Reservoirs may be placed
directly over or slightly distal to the burr hole. This information is crucial when
emergent access to the burr hole is needed. The distal shunt tubing leads from the
reservoir unit to a part of the body that can accept the drained CSF, usually the
peritoneum. The distal tubing may also be located in the vascular system or
pleural cavity. Ventricular–atrial shunts are less commonly inserted because of the
serious infectious complications that have occurred with these types of shunts, but
may be necessary due to severe scarring in the peritoneum. All modern shunt
tubing is made of 1/8-in diameter Silastic elastomer, which causes minimal
omental reaction and is resistant to cracking.
