Diagnosis &Treatment Options

[Diane-Horner]

  My daughter, age 18, was diagnosed with hydrocephalus secondary to grade III
  intraventicular hemorrhage 3 days after premature birth.  She has a
  complicated history with many, many surgeries and types of shunts. Her
  current shunts were placed in her right venticle and another in a 4th
  venticle cyst in 6/96  These two shunts are "Y"ed together into a single
  drain into her peritoneal cavity. At the present time she is experiencing a
  build-up a CSF in her abdominal cavity. This is the third time this has
  happened. The last time (5/91)this fluid is very high in protein. Her
  neurosurgeon has not seen this happen before and yesterday referred us to a
  gastroenterologist for further work-up.  I post this in hopes of finding
  someone who has seen these symptoms and can offer an explanation as to why
  this may be happening or have another treatment other than surgical
  intervention to move the distal end of the shunt to another body cavity.
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Dear Diane,
A few things may be going on.  First, the shunt may be infected.  Many different
kinds of bacteria can infect a shunt.  Some are aggressive and present with
meningitis while some are more indolent and present with cysts in the abdomen
and shunt malfunctions.  By definition, at least at the Cleveland Clinic, a
shunted patient with a cyst around the shunt tip in the abdomen has an infection
until proven otherwise.  It may take as long as 10 days for the microbiology
lab to grow the organism from the CSF.  If infected, the shunt needs to be
removed and IV antibiotics started until the infection is resolved, at which
time another shunt may be placed.
Second, some patients who have had abdominal diseases have difficulty absorbing
the spinal fluid from the shunt.  If this is the case, the shunt may be placed
into a vein in the neck for drainage.  An infection, as discussed above, should
be ruled out, however, prior to conversion to venous drainage.
You should discuss these issues with your neurosurgeon and get his or her
opinion.  Unfortunately shunts can at times be complicated, and there are
often few options besides further surgery.
Good luck.