Cerebrospinal fluid shunt management .1.

BACKGROUND- Modern cerebrospinal shunts compatible with long-term survival date back to the early 1960s. Therefore, an increasingly larger number of patients shunted in childhood are reaching adulthood and the neurologist is being called upon to care for them. A shunt is compatible with a normal life without any particular restrictions; however, it can malfunction at any time and become life threatening. With increasing ease of travel and a wider variety of shunting devices available, patients with different types of devices may present for follow-up or urgent treatment. Therefore, it is important that the pediatric or adult neurologist be familiar with cerebrospinal fluid (CSF) shunts. REVIEW SUMMARY- The management of a patient with a CSF device can be complex. This review will address neurosurgical issues as they relate to the care of a patient with hydrocephalus. The major indication for the creation of a CSF shunt is to lessen the CSF absorption resistance. In Part I, indications, contraindications, alternatives to shunting, and various devices are discussed. Part II will discuss the acute and chronic complications associated with CSF shunts. Suggestions regarding methods of detection, management, and prevention of a shunt malfunction will be presented. CONCLUSIONS- CSF shunts have the highest reoperation rate of all neurosurgical procedures. Recent technological advances will hopefully lessen the rate of complications associated with overdrainage and occlusion.