The document discusses hydrocephalus and the use of shunt systems to treat it. Hydrocephalus is a condition where cerebrospinal fluid builds up in the brain, increasing pressure. If left untreated it can be fatal. A shunt system works by draining excess fluid from the ventricles of the brain to other parts of the body through a series of catheters and a valve that regulates flow. Programmable shunt valves allow doctors to adjust pressure settings non-invasively. The document also profiles individuals living with hydrocephalus and shunts, including a race car driver who has undergone over 20 brain surgeries.

2. Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

3. Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

4. 99.13% Water
0.87% Both organic and inorganic solids:
Produced within the ventricles of the brain and
partially by the choroid plexus, and is absorbed by
the dural venous sinuses
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

5. Skull
(hard and rigid with a fixed volume)
Brain Tissue Vascular System (arteries
& blood)
CSF
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

6. Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

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Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates
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The skull limits the expansion of fluid: Increased fluid means increased pressure on the brain
Fatal if left untreated

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Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

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Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

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Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

11. Over 400 types of shunts
3 main parts:
• Proximal (Ventricular) catheter
• Distal catheter
• Shunt valve
Fig 10: Lateral view of shunt system
Fig 9: Frontal view of shunt system
Fig 8: Major components of a shunt system
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

12. • Drains excess fluid from the ventricles
• Made from silicon rubber
• May be coated with barium for x-ray visibility
• Sometimes antibiotic impregnated (rifampicin
and clindamycin)
• 15 cm - 23 cm in length
• Inner diameter 1.0-1.6mm
• External diameter 2.1-3.2 mm
• May be straight, flanged, or J-shaped
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

13. • Routed from the burr hole in the
skull
• Made from silicon rubber
• May be coated with barium for x-
ray visibility
• 90 cm - 120 cm in length
• Inner diameter 0.7-1.3mm
• External diameter 2.1-2.5 mm
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

14. Distal end of the catheter can be
routed to the:
• Heart: Ventriculoatrial (VA) shunt
• Lungs: Ventriculopleural (VPLS)
shunt
• Abdomen: Ventriculoperitoneal
(VP) shunt
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

15. • Regulate flow of CSF from ventricles
• Nearly 200 types of shunt valves
• Operation based on Hydrostatic Pressure:
𝐻𝑆𝑃 = 𝜌𝑔ℎ
If patient is in horizontal position, less
fluid flows (2 drops/min). If in vertical
position, more fluid flows (4drops/min)
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

16. • Function based on opening pressure (OP) and closing pressure (CP) of the
valve
Differential Pressure: DP = ICP + HSP – IAP
OP < DP: valve opens
CP < DP: valve closes
*ICP Intracranial Pressure, *IAP Intraabdominal Pressure
• Types include: Slit valves, Mitre valves, Diaphragm valves, Ball-in-cone
valves
• Ball-in-cone (Ball-spring valve) most efficient: offers maximum flow when
DP > OP
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

17. • Designed to avoid over-drainage resulting from change in HSP (siphoning)
• Referred to as anti-siphoning devices
• Three types:
• Suction controlled devices – contains a flexible membrane valve that
regulates pushing pressure (PP) and sucking pressure (SP). When PP > SP,
CSF flows. When PP < SP, no CSF flows
• Flow reducing devices – CSF flow based on differential pressure
• Gravitational valve – uses metal ball to regulate flow across opening
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

18. proGAV 2.0® with ShuntAssistant®
• Hybrid valve: proGAV Combines DPV with HSV to avoid
siphoning
• Able to regulate OP with posture changes
The bow spring controls the OP of the ball-in-cone valve.
The tension of the spring (OP) is controlled by turning the
rotor.
The tantalum ball defines the OP of the valve, and the
sapphire ball ensures the valve is fully closed.
SAPPHIRE BALL
BOW SPRING
ROTOR
CONNECTOR UNDER
THE SILICONE CATHETER
TANTALUM BALL
SAPPHIRE BALL
ADJUSTABLE UNIT
GRAVITATIONAL
UNIT
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

19. proGAV 2.0® with ShuntAssistant®
When patient is in the vertical position:
a) Gravitational unit closes
b) When: 𝑊𝑒𝑖𝑔ℎ𝑡 𝑇𝑎𝑛𝐵𝑎𝑙𝑙 < 𝑂𝑃𝐺𝑟𝑎𝑣𝑈𝑛𝑖𝑡
 Fluid flows freely
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

20. proGAV 2.0® with ShuntAssistant®
When patient is in the horizontal position, the gravitational unit
stays open, allowing fluid to flow freely
Fig 21: ShuntAssistant in horizontal position
Fig 22: ShuntAssistant in horizontal position
Fig 23: Adjustable (Differential Pressure) DP-unit a) closed, b) open
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

21. proGAV 2.0® with
ShuntAssistant®
IVP Intraventricular pressure
𝑃𝐿 Opening pressure in horizontal position
(adjustable DP-unit only)
𝑃𝑆 Opening pressure in vertical position
(adjustable DP-unit + gravitational unit)
𝑃𝐵 Pressure in the abdominal cavity
𝑃 𝐻 Hydrostatic pressure
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

22. proGAV 2.0® with ShuntAssistant®
• DPV controlled externally with a magnetic “Compass”
• Rotorbrake makes a clicking sound when released/locked
• Shunt valve is MRI safe up to 3 Tesla
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

23. proGAV 2.0® with ShuntAssistant®
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

24. Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

25. • Diagnosed with spontaneous Hydrocephalus at age 12
• Had 15 shunt related surgeries in 3 years
• Shunt was a free flowing shunt: the only way to regulate the amount of CSF was
to change his position from sitting/standing to lying down
• Received first programmable shunt in 2006
• Brain tear and damage from multiple surgeries left him permanently disabled in
2010
• Has had a total of 20 brain surgeries to date
• Current shunt is a programmable proGAV 2.0® with ShuntAssistant®
Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

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27. Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

28. Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

29. Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

30. Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

31. Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

32. Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

33. Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

34. Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates

35. Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates
Dick Wagner
Former lead guitarist for Aerosmith, Alice Cooper,
and Kiss
Gabby Giffords
Former member of the US House
of Representatives
George Visger
Former defensive lineman for the
San Francisco 49ers

36. Skulls, Tattoos and Race Cars: Understanding Hydrocephalus and Shunts Desiree Bates