Hydrocephalus / Ventricular Shunts
What is hydrocephalus?
Hydrocephalus occurs when too much cerebrospinal fluid (CSF) builds up within the chambers (ventricles) inside the brain. CSF is a clear fluid produced within the brain that flows through the ventricles and then is reabsorbed back into the bloodstream. If not enough CSF is absorbed or if there is a blockage of CSF flow, fluid builds up and may cause the ventricles in the brain to enlarge. As ventricles enlarge, the head may enlarge as well. Hydrocephalus is not a disease, but the result of a disease process that causes the build up of CSF.
Your child may need a shunt to relieve the buildup of CSF. This procedure is done by the doctor in the operating room.
What is a ventricular shunt?
The purpose of the shunt is to reduce the amount of CSF in the brain by draining it to the abdomen or directly into a chamber of the heart. This shunting of CSF helps reduce the pressure on the brain.
A shunt is a hollow plastic tube that is placed in the ventricle of the brain. The tube is attached to a valve and is then threaded under the skin from the brain to the abdomen (peritoneum). This is called a V-P shunt (Ventricular-Peritoneal shunt). In some children, the tube runs from the ventricle of the brain to the heart (atrium). This is called a V-A shunt (Ventricular-Atrial shunt). There are pictures of the two types of shunts in the pictures above. The shunt has a valve, which controls the amount of fluid that flows from the brain to the abdomen or heart.
The most common complications of a ventricular shunt are infection and malfunction. Malfunction can be caused by blockage in the shunt, the shunt breaking or because a valve in the shunt is not working.
How do you know when a shunt is infected or malfunctioning?
Infection: The signs and symptoms of a shunt infection are:
- Fever greater than 101.5°F (38.2°C) rectally or greater than 100.5°F by mouth
- Swelling, redness or drainage along the shunt tract or incision site
- Poor feeding/vomiting
- Headache (in older children)
- Stiff neck
- Persistent abdominal complaints
Shunt malfunction: Blockage or breaks along any part of the shunt will cause pressure in the brain because the CSF cannot be drained into the abdomen or heart. Signs and symptoms of shunt malfunction are:
- Infants and Toddlers (before soft spot closes)
- Tenseness, swelling or widening of the soft spot
- Poor feeding/ persistent vomiting
- Abnormal quietness or unresponsiveness
- Change in tone of crying - may be weak, shrill or high-pitched
- "Setting-sun" eyes (Can't look up)
- Children and Adolescents (after soft spot closes)
- Loss of appetite/persistent vomiting
- Change in behavior
- Vision/eye problems
- School problems
- Coordination problems
- Abnormal sleepiness
- Unequal pupils
If you notice any of the above signs, call your child's doctor.
What is an external ventricular drain (EVD)?
An EVD is a small tube used to drain excess fluid from the brain. It is used to treat hydrocephalus before a permanent shunt can be placed or if the child’s shunt malfunctions or becomes infected. The EVD drains the extra CSF into a bag that is mounted on an IV pole at your child’s bedside. This system allows the nurses and doctors to check the drainage and determine the best treatment for your child.
- Precautions to take when an EVD is in place: Do not allow your child to get out of bed without the assistance of the nursing staff. Caution must be taken to avoid the dislodgement of the tube. If your child wants to change position in the bed, get the nurse. The nurse will need to adjust the system so it will continue to work properly after the position change.
- Removal of the drain: The ventricular drain will be changed in the operating room into a shunt as described on the first page. If the child had a shunt before the EVD was placed, this operation is called “reinternalization” of the shunt.
This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.