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Review
. 2019 Nov 5:48:100-104.
doi: 10.1016/j.amsu.2019.10.033. eCollection 2019 Dec.

CSF-diverting shunts: Implications for abdominal and pelvic surgeons; a review and pragmatic overview

Aimee Goel  1 , Claudia Craven  1 , Samir Matloob  1 , Simon Thompson  1 , Laurence Watkins  1 , Ahmed Toma  1
Affiliations
Review

CSF-diverting shunts: Implications for abdominal and pelvic surgeons; a review and pragmatic overview

Aimee Goel et al. Ann Med Surg (Lond). .

Abstract

The optimal management of patients with ventriculoperitoneal or lumboperitoneal shunts undergoing abdominal or pelvic surgery for unrelated reasons is often unclear due to the paucity of guidelines in this field. In this review, we outline key issues in managing these patients. Specifically, we address issues relating to pre-operative planning, avoidance of shunt-related complications such as infection and malfunction, and specific management of neurological symptoms in the post-operative period. A retrospective study was carried out analysing correspondence between general surgeons and a specialist hydrocephalus unit over a 4-year period relating to management of patients with ventriculoperitoneal and lumboperitoneal shunts undergoing abdominal or pelvic surgery. A literature review was carried out to identify available evidence in this field. 30 queries from general surgeons were identified comprising 12 main themes. 16 relevant publications were identified. We summarised these to answer these queries. The management of shunted patients may present challenges and uncertainties in an abdominal or pelvic surgery setting. This paper provides guidelines and clarity in this field by discussing and summarising reported data in the literature.

Keywords: Abdominal surgery; CSF-Diverting shunt; Neurosurgery; Pelvic surgery; Shunt.

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Conflict of interest statement

No conflicts of interest.

Figures

Fig. 1
Fig. 1
Lateral skull X-ray confirming a ventricular shunt including the proximal ventricular catheter (A), reservoir (B), adjustable valve (C), gravitation unit (D), and the distal catheter tunnelled subcutaneously (E).
Fig. 2
Fig. 2
Lateral abdominal radiograph confirming an LP shunt with its proximal catheter within the spinal canal (B), a valve (A), and the distal catheter tip (C) lying intraperitoneally. Figure adapted from Toma et al., 2010 [2].
Fig. 3
Fig. 3
Radiographic appearances of some commonly used shunt valve systems, Codman Hakim (A), Medtronic Strata (B), Sophysa Sophy SM6 (C), Aesculap Miethke ProGAV (D). Figures adapted from Lollis et al., 2010 and Handbook of Neurosurgery, Greenberg, 2010 [3,4].
Fig. 4
Fig. 4
An externalised shortened shunt connected to a Becker drain set (image A) using a connector (image B) and placed level with the abdomen.
Fig. 5
Fig. 5
Abdominal X-rays in AP (A) and lateral (B) views in different patients showing incorrectly positioned extra-peritoneal VP shunt tubing.
See this image and copyright information in PMC

References

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