Shunts to treat hydrocephalus

Why use a shunt?

Shunts are used to manage a condition called hydrocephalus. If your child is diagnosed with hydrocephalus then using a shunt to manage their symptoms and keep them well will be considered by the neurosurgical team here at the Children’s.

How does a shunt work?

A shunt is a long thin tube, that works by draining away the excess cerebro-spinal fluid (CSF) from fluid filled spaces in the brain. The top end of the shunt catheter sits within the largest fluid space (ventricle). From here the CSF drains through the catheter to the shunt valve, which sits on the surface of the skull but under the skin. The valve regulates the flow of the fluid. The fluid then drains down through the rest of the catheter which sits underneath the skin.

Are there different types of shunts?

There are a number of different shunts used to treat hydrocephalus, the neurosurgical team will decide which one is best for your child. There are also 3 different places that the fluid can be drained to.

1. Ventriculo-atrial (VA) shunt – Drains from the ventricles into the heart. The catheter enters the large artery and drains directly into bloods system.
2. Ventriculo-peritoneal (VP) shunt – Drains from the ventricles to around your tummy where your organs sit. The shunt does not drain into any of theses organs but the space between them. From here the fluid reabsorbs into the blood system.
3. Ventricular-plural shunt (VPl) – Drains from the ventricles into the space around the lungs, or the ‘plural’ space. From here it is reabsorbed.

A VP shunt (centre image) is the most commonly used. The other 2 types are only used if there is a medical reason why the tummy is not suitable.

How is the shunt put in place?

A shunt is inserted under a general anaesthetic in the theatre department. A small hole is made in the skull for the catheter to be inserted into the ventricular system. Then the reservoir valve and anti-siphon devices are placed in the correct position behind the ear. A small opening is made in the abdomen, the lower end of the catheter is then fed under the skin to be attached to the top end of the shunt, and the length of the catheter is left coiled in the abdomen.

How long does the surgery take?

The surgery time is only about half an hour to an hour but the preparation and recovery time will prolong the time that your child will need to be away from you.

Will it be painful?

Pain relief will be given during the operation. Once back on the ward your child will be given paracetamol and ibuprofen as pain relief.

Often the only area that is sore is the abdominal opening.

What will the wounds or scars look like?

Your child will have two wounds. The one at the top will be C-shaped, positioned above and behind the ear. We rarely shave any hair on the scalp. The second will be on the tummy, above the belly button and off to one side.

Under the wound on the head sits the reservoir and a valve. After the operation these areas will be raised but the swelling will settle. Over time the different parts of the shunt will become less apparent due to growth and hair.

The wounds are stitched closed with dissolvable stitches.

If repeated surgery is needed then the same openings are used where possible.

What length of hospital stay is needed?

This depends on a number of factors. For discharge a full recovery from surgery is required. This means:

• Returning to normal mobility
• Diet and fluid intake
• Stable observations
• Pain management
• Approval of the clinical team

The minimum stay on the ward is usually 2 nights.

What is the best way to look after wounds once we are home?

Keep both wounds dry for 5 days. Then you can then wash them. The wounds should be washed with shampoo only, until 2 weeks after the surgery. Once the wounds are healed and the stitches are dissolved you can then start to use conditioners and other hair products.

If the wounds become swollen, red or have ANY discharge please contact us directly.

Please don’t ask you GP or local service to treat you without speaking to the neurosurgical team first.

What are the side effects of having a shunt?

Shunts can malfunction, block or become infected.

If this happens then the symptoms of hydrocephalus will return.

These are some of the more common things to look out for.

In children under 2 years old, side effects include:

• increased head size (usually over a short period of time)
• tense or bulging fontanelle (soft spot on head)
• thin shiny skin with enlarged veins on the scalp
• drowsiness
• being sick
• irritability
• downward-looking or ‘setting sun’ eyes
• occasional seizures or fits
• poor feeding

In children over 2 years old, side effects include:

• headaches
• feeling sick or refusing food
• being sick
• irritability
• drowsiness, sleepy, or hard to wake
• balance problems
• changes in behaviour
• downward-looking or ‘setting sun’ eyes
• seizures or fits
• dislike of bright lights
• failure to thrive
• poor school performance

What should we do if we think there is a problem with the shunt?

Contact us directly by calling the ward on 0114 271 7784  or 0114 271 7758.

We will arrange to see you. However if your child is becoming more unwell you will be asked to attend your local Emergency Department. If there is a problem with the shunt then treatment will be provided by the neurosurgical team. This may mean replacing the shunt or changing a part.

Is there anything that should be avoided?

Once your child has recovered from surgery then everything should be done to return to normal activities. Contact sport such as rugby and boxing should be avoided, avoiding direct blows to the head. It is always important to wear a well-fitting cycling helmet when doing activities such as cycling, scootering, or skateboarding for example.

Returning to school or nursery

Your child should have at least 1 week off following surgery to recover and for the wounds to heal. You may find that at first school and other activities make them more tired than usual. It takes differing amounts of time to return to normal. If you are concerned please contact the ward.

Can we go on holiday?

Yes. If you are going on holiday please consider the healthcare available in that region and inform your insurance company. We can provide you with a letter to take with you.

Is it okay to have scans?

If your child has a programmable shunt in place then the setting will need to be checked following an MRI scan. This can be done by the team here at Sheffield Children’s. CT scans and X-rays cause no problems.

Your shunt details