Evaluation of ventriculoperitoneal shunt emergencies

Abstract

Ventriculoperitoneal shunt (VPS) placement, the placement of a silastic, or flexible plastic, shunt which allows drainage of the cerebrospinal fluid into the peritoneum in order to decrease intracranial pressure, is a neurosurgical procedure that is performed to relieve a number of pathologic entities. The most common indication for Ventriculoperitoneal shunt placement is hydrocephalus, or increased intracranial pressure (ICP) and ventricular size secondary to a mismatch between cerebrospinal fluid production and absorption. Hydrocephalus is a physiologic and anatomic state that may occur from a variety of etiologies both congenital and acquired (see Table 1). The current rate of VPS placement is unknown, but some estimate that there are approximately 18,000 to 50,000 shunt placements per year in the United States, and the incidence is rising each year [4,12]. The increase in shunt placement procedures is in part due to advances in neonatology with the consequent resuscitation of very premature infants who are at increased risk for common causes of hydrocephalus such as intraventricular hemorrhage and central nervous system infection [12]. According to some estimates as many as 40% of VPS’s fail in the first year and 56–80% will have at least one episode of malfunction over 10 years [19]. Advances in the care of patients undergoing this procedure have lead to greater survival and quality of life. Thus, it is important for practitioners to be familiar with the life-threatening