doctors doing surgery: shunt revision

Mabel’s neighbor’s son is in the hospital for a shunt revision. She sees her neighbor posting updates on Facebook, “We’re in the ED. They are tapping Dan’s shunt.” And later she sees, “The shunt is clogged. It looks like we have to do a revision.”

This information sounds concerning to Mabel. But she’s not exactly sure what it all means. She knows Dan has been to the doctor a lot. She even knows Dan has a shunt. But if she had to answer questions about it as a contestant on Jeopardy, the guy named Walt in the tweed sport coat would certainly win.

What Is A Shunt?

First, Mabel needs to know what a shunt is. There are lots of different kinds of medical shunts. The word shunt means a passage that allows fluid to move from one place to the other.

Dan has a brain shunt. This shunt is a medical device that moves fluid from inside the brain to somewhere else in the body.

Shunts have multiple parts. The shunt catheter looks like a little straw. It is inserted into the ventricles (open space inside the brain) to drain off the extra cerebrospinal fluid (CSF). The catheter leads into a reservoir. This little tank holds some of the fluid so the doctors can use it for testing, if necessary. Under the reservoir is a valve that regulates, based on pressure, how much fluid is allowed to flow out of the brain. Beyond that is the tubing, sometimes also referred to as a catheter, that takes the fluid away from the brain into another part of the body where it is absorbed.

Who Needs A Shunt?

diagram of a brain

In hydrocephalus, there is too much fluid in the ventricles of the brain.

Mabel also needs to know what shunts are for. Shunts are used to treat hydrocephalus. Hydrocephalus is a condition where excess fluid builds up in your brain. A long time ago people called this “water on the brain.” Although people of any age can develop a need for a shunt, most of the people that need one are either babies or older adults.

The National Institute of Neurological Disorders and Stroke estimate that one or two out of every 1,000 babies are born needing a shunt. Some of them create too much fluid. Some of them can’t properly absorb the fluid they make. Others have something causing a blockage that prevents the fluid from flowing freely through the brain.

In Dan’s case, there is a blockage that prevents the fluid from flowing freely. This blockage will never go away, and he will always need a shunt. Some people’s problems resolve, and they outgrow the need for a shunt.

How Can A Shunt Malfunction?

Before her neighbor left for the hospital, Mabel heard her talking about the possibility of a shunt malfunction. Mabel knew that meant the shunt wasn’t working properly, but she didn’t know how this could happen.

Shunts can malfunction for several reasons. Sometimes pieces of them break. The danger of breakage is why people with shunts are discouraged from playing contact sports, like football. One time Dan’s sister threw a ball that hit him on the side of the head. Dan had to go to the doctor to make sure his shunt was still working.

Usually, shunts malfunction because they get clogged or blocked. The small catheter in the brain can clog up with blood or choroid plexus (brain tissue). Choroid plexus is a lot like seaweed, so it can wave around and get stuck to the catheter. A shunt can also get clogged with bacteria.

Other reasons for failure are when there is a mechanical failure of the valve, the tubing to the abdomen gets blocked or kinked, or the child grows and needs the tubing to be extended.

What Is A Shunt Revision?

Mabel is still wondering what a shunt revision is. To her, the word revision sounds like someone is editing an English paper.

Shunt revisions are surgical procedures. The definition of revision is to alter something, whether it is an English paper or a piece of medical equipment. So during this surgery, the doctor will alter the shunt in a way that makes it functional again.

During a shunt revision, a neurosurgeon first cuts a slit in the patient’s scalp. If they do not already know why the shunt is malfunctioning, they will do some exploring to figure out the cause.

If the cause is a clotted ventricular catheter, they may only have to replace that one part. If the tubing that drains the fluid away is clogged, the surgeon will have to make another incision in the area that the tubing leads to be able to replace it. Other problems may require them replacing the entire shunt system.

What Can I Do?

Mabel is concerned for her neighbor’s son. She doesn’t know how long he will be in the hospital or how he will feel.

Like any surgery, outcomes can be different. Typically, after surgery, Dan should be in the hospital for only one or two nights. Once he gets home, his parents will still be busy helping him recover for the next few days.

Even though the shunt revision will make him feel better in the long run, he will still feel bad from the surgery. Depending on how long the shunt had been malfunctioning, and the cause, Dan could be almost back to normal in a couple of days, or he could feel sick for quite a while.

Mabel can do any of the things she would usually do to help someone that has just had surgery, but she should keep in mind that every situation is different, and asking what the family needs is always the best plan.

Photo Credit: U.S. Pacific Fleet Flickr via Compfight cc

Photo Credit: National Institutes of Health (NIH) Flickr via Compfight cc