General overview of CSF diversion procedures and their complications.

1. Complications Of CSF diversion
procedures with their management:
Dr Shaheer Anwar
Resident Neurosurgeon.

2. Objectives:
• Definition Of Hydrocephalus.
• CSF diversion procedures.
• Complications of CSF diversion.
• Management Of CSF diversion.

3. Definition of Hydrocephalus:
Dilatation of the ventricles due imbalance
between the production and drainage of the
CSF.

4. CSF diversion procedures:
• Ventriculoperitoneal Shunt.
• Ventriculoatrial Shunt.
• Lumoperitoneal Shunt.
• Torkildsen Shunt.
• Cyst/Subdural peritoneal Shunt.

5. Ventriculo-peritoneal Shunt
• Most commonly used shunt in modern era
• Lateral ventricle is the usual proximal location

6. Ventriculoatrial Shunt:
• Through jugular veins to superior Vena cava
• Treatment of choice in abdominal
abnormalities.

7. Torkildsen Shunt:
• Shunting ventricle to cisternal space
• Rarely used
• Effective only in acquired obstructive
hydrocephalus.

8. Cyst/Subdural-peritoneal Shunt:
• Draining arachnoid cyst/subdural hygroma
cavity.

9. Complications of CSF diversion:
• The likelihood of shunt failure is 40% in the
first year after shunt implantation.
• Most common presentation of a shunt failure
is typical hydrocephalic presentation
• Multiple shunt failures in a patient usually has
the identical picture of presentation
• Ventricle size reduces at the end of the first
post-op year.

10. Slit LikeVentricles Syndrome:
• The lateral ventricles collapse secondary to
overshunting or remain at a fixed size causes
subependymal gliosis.
• Intermittent or complete shunt malfunction.
• Raised ICP without ventricular enlargement.
• Unresponsive ventricles.
• Progressive neurological deterioration secondary to
raised ICP may require subtemporal decompression.
• Third ventriculostomy possible during periods of
relative ventricular dilation.

11. General Complications:
a. Obstruction.
b. Disconnection.
c. Infection.
d. Erosion through Skin.
e. Seizures.
f. Silicone allergy.

12. With VP Shunting:
a. Inguinal hernia: 17% incidence.
b. Needs lengthening with age.
c. Obstruction.
d. Malposition of tip.
e. Peritonitis with shunt infection.
f. Hydrocele.
g. CSF ascites.
h. Migration into scrotum/bowel/stomach.
i. Intestinal obstruction.
j. Volvulus.
k. Subdural Hematoma due to over dainage.

13. With VA Shunting:
• Requires repeated lengthening.
• High risk of infection/septicaemia.
• Risk of retrograde flow of blood.
• In case of valve malfunction (rare)
• Shunt embolus
• Vascular complications
• Perforation, thrombophlebitis, pulmonary
micro-emboli.

14. LP Shunt:
• Laminectomy incurs 15% chance of scoliosis
• Progressive cerebellar tonsillar herniation (up to 70%)
• Slit ventricle syndrome
• Overshunting is harder to control
• Difficult proximal end revision (if required)
• Lumber radiculopathy
• CSF leak
• Difficult pressure regulation
• Bilateral 6th, 7th, nerve dysfunction due to
overshunting
• High incidence of arachnoiditis & adhesions:

15. Management Of complications of CSF
diversion.
• Intravenous antibiotics after culture and
sensitivity along with Shunt revision if shunt is
blocked due to infection.
• Shunt tie in case of overdrainage of CSF.
• Shunt tie along with burrhole evacuation of
subdural hematoma in case of bilateral
subdural hematoma due to over drainage.

16. THANKS.