Cerebrospinal Fluid (CSF) Shunt
What is a cerebrospinal fluid (CSF) shunt?
A cerebrospinal fluid (CSF) shunt is a device used to drain a buildup of CSF in the brain (hydrocephalus). CSF is a clear fluid that normally surrounds and protects the brain and spinal cord. Too much CSF can put pressure on the brain and cause serious brain damage. A CSF shunt is a tube inserted surgically that prevents brain damage by draining excessive fluid into the abdomen or heart.
Hydrocephalus results from a blockage in the system that regulates CSF and drains excessive fluid. It can be due to head injury, stroke, infection, tumor, or surgery. Hydrocephalus may also be present at birth due to abnormal genes or other factors that affect pregnancy.
A CSF shunt and surgery to insert it has serious risks and potential complications. You may have other surgical treatment options. Consider getting a second opinion about all of your treatment choices before having a CSF shunt.
Types of CSF shunts
The types of CSF shunts include:
Lumboperitoneal shunt drains CSF from the subarachnoid space in the lumbar spine (lower back) into the abdomen
Ventriculoatrial shunt drains CSF from the ventricles of the brain into the heart
Ventriculoperitoneal shunt drains CSF from the ventricles of the brain into the abdomen
Other procedures that may be performed
Your doctor may perform other procedures in addition to CSF shunt surgery. These include:
Intracranial pressure (ICP) or spinal fluid pressure monitoring to diagnose and check CSF pressure
Lumbar puncture or catheter to remove excess CSF. This can relieve symptoms temporarily and help your doctor diagnose hydrocephalus.
Why is cerebrospinal fluid (CSF) shunt surgery performed?
Your doctor may recommend surgery to insert a cerebrospinal fluid (CSF) shunt to treat hydrocephalus. This condition causes excess buildup of CSF in the brain. CSF is a clear fluid that surrounds the brain and spinal cord. It normally cushions and protects the brain, but too much can put pressure on the brain and cause problems with brain function.
The effects of hydrocephalus vary depending on the type and cause of hydrocephalus. Symptoms and problems in infants include:
Behavior problems, such as poor feeding, sleepiness, irritability, and high-pitched cry
Large or rapidly growing head
Sunset eye sign, a fixed downward gaze of the eyes in which the whites are visible over the pupils
Symptoms and problems in older children and adults include:
Movement problems including slow movements and problems with balance, coordination and walking
Nausea and vomiting
Poor development in a child
Ask your doctor about all of your surgical options for treating hydrocephalus and consider getting a second opinion.
Who performs cerebrospinal fluid (CSF) shunt surgery?
Neurosurgeons and pediatric neurosurgeons perform surgery to insert a CSF shunt. Neurosurgeons specialize in the surgical care of diseases and conditions of the brain and nervous system. Pediatric neurosurgeons specialize in the surgical care of diseases and conditions of an infant’s or child’s brain and nervous system.
How is cerebrospinal fluid (CSF) shunt surgery performed?
Your doctor will perform cerebrospinal fluid (CSF) shunt surgery in a hospital. The procedure involves inserting one end of the shunt tubing into the space that contains CSF in the brain (ventricle) or spine (subarachnoid space). The lower end of the shunt tubing runs under the skin into the abdomen or heart, where excessive CSF will drain and absorb harmlessly into the body.
Your doctor surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different types of CSF shunts and procedures and ask why your doctor will use a certain type for you.
Types of anesthesia
Your doctor will perform CSF shunt using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain.
What to expect the day of your CSF shunt
The day of your surgery or procedure, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a cerebrospinal fluid (CSF) shunt?
As with all surgeries, inserting a cerebrospinal fluid (CSF) shunt involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock or require blood transfusion
Potential complications of a CSF shunt
Complications of CSF shunt vary, depending on the procedure, but can include:
Adverse reaction to the shunt
Bleeding or blood clot in the brain
Lung or kidney problems
Meningitis, an infection of the CSF
Problems in the abdomen including bowel rupture and twisting of the intestine around the shunt tubing
Shunt malfunction, breakage, movement, blockage or infection
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Informing your doctor if you are nursing or if there is any possibility of pregnancy
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my a cerebrospinal fluid (CSF) shunt?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for cerebrospinal fluid (CSF) shunt surgery by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include lumbar puncture, imaging tests, intracranial pressure monitoring, blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan.
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions and a friend or family member to your appointments. Questions can include:
Why do I need CSF shunt? Are there any other options for treating my condition?
Which type of procedure or surgery do I need? Will my shunt drain CSF from the lower back or brain? Will my shunt drain into the abdomen or heart?
How long will my surgery take? When can I go home?
What restrictions will I have after surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How do I take my regular medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my cerebrospinal fluid (CSF) shunt surgery?
Knowing what to expect can help make your road to recovery after cerebrospinal fluid (CSF) shunt surgery as smooth as possible.
How long will it take to recover?
Recovery will vary, depending on your age, diagnosis, general health, and the type of shunt and surgery you had. You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable.
You may stay in a neurological intensive care unit (neuro ICU) after surgery. Neuro ICUs provide 24-hour monitoring and highly specialized critical care for people with brain and nervous system diseases and conditions. Your care team will check the pressure in your brain and your brain function frequently while you are in the hospital.
It may take a few hours until the major effects of general anesthesia wear off and you are alert. When you wake up, you may have a breathing tube in your mouth and tubes and wires attached to your body. These allow your team to monitor your vital signs and pressure in your brain, drain bodily fluids, take blood, and give medications and fluids.
You will not be able to talk if you have a breathing tube. Your care team usually removes it within a few days. You may have a sore throat from the tube. This is usually temporary, but tell your care team if you are uncomfortable.
You may move to a hospital room outside the neuro ICU as you recover. The length of a hospital stay after CSF shunt surgery varies from one to seven days. Your stay will depend on the type shunt, and your condition, general health, age, and other factors.
Full recovery is a gradual process. Your doctor may refer you to rehabilitation program that includes physical and occupational therapy to help you recover and improve functioning. Ask your doctor what to expect after your repair and for your recovery.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your CSF shunt surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after CSF shunt surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Chest pain or a pounding, racing heart
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Nausea and vomiting
Problems with vision, speech, memory, coordination, balance, or muscle control
Return of any symptoms of hydrocephalus
Unexpected drainage, pus, redness or swelling of your incision
How might a CSF shunt affect my everyday life?
A CSF shunt is an effective treatment for hydrocephalus and improves the quality of life for most people. It can reduce or eliminate serious symptoms and lower your risk of permanent brain and nervous system damage. Having a CSF shunt also causes significant changes that affect your everyday life, such as the need to:
Have frequent follow-up visits with your doctor and tests to monitor your condition
Have more surgery to replace your CSF shunt. Shunts generally last about ten years in adults. They need more frequent replacement in children as they grow.
Notify all of your healthcare providers about your CSF shunt