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ventriculoperitoneal (VP) shunt
An artificial passage (shunt) from the cerebral ventricle(s) into the peritoneum.
Indications:
- hydrocephalus
a) increased intracranial pressure
b) normal pressure hydrocephalus
Special laboratory:
- shunt malfunction or suboptimal function:
a) if programmable valve was placed, lowering the pressure setting may be indicated [2]
b) lumbar tap tests
c) CSF infusion tests [3]
Radiology:
- CT scan is not a reliable indicator of shunt function [1]
Complications:
1) shunt infection
2) shunt occlusion
3) most shunt complications occur within 1st year, but risk is long-term [4]
Management:
- shunt infection
- bacterial meningitis
- vancomycin plus ceftazidime, cefepime or meropenem [5]
- gram-negative coverage for Pseudomonas aeruginosa & Acinetobacter baumannii [5]
- intravenous & intraventricular antimicrobial therapy (usually vancomycin or gentamicin) may be required to eradicate infection, especially in patients with multidrug-resistant gram-negative bacilli (e.g., Acinetobacter baumannii)
- removal of infected external or internal ventricular catheter
General
ventriculostomy; ventricular shunt
cerebrospinal fluid drainage device
References
- UpToDate Online version 17.1
- Vanneste JA
Diagnosis and management of normal pressure hydrocephalus
J Neurol 2000, 247:5
PMID: 10701891
- Malm J et al,
CSF outflow resistance as a predictor of shunt function.
A long-term study
Acta Neurol Scand 2004, 110:154
PMID: 15285771
- Pujari S et al,
Normal pressure hydrocephalus: long-term outcome after shunt
surgery.
J Neurol Neurosurg Psychiatry 2008, 79:1282
PMID: 18356257
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015