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VP shunt removal
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VP shunt removal


    
      Re: VP shunt removal
    


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Posted by CCF Neurosurgery MD on December 22, 1997 at 09:45:52:

In Reply to: VP shunt removal posted by Lynne Jarvis on December 20, 1997 at 06:03:32:

: Please allow me to begin by saying that we are very satisfied with the care our daughter's nuerosurgeon is offering her.  Her case is a bit complicated, however, and we would feel better with all the info. we can collect.  Our daughter, who is almost 8 yrs., has been shunted since 18mos.  Her original shunt was a subduroperitoneal one.  It was placed to treat extraaxial fluid collections resulting from birth trauma (very rapid delivery).  In 1995, her previous neurosurgeon noted that her fluid collections had resolved and she could have her shunt removed in the near future.  We were advised to give our daughter one more year with the shunt and to return for an examination in 1996.  We did so and, upon that examination, it was discovered that our daughter's subdural shunt had failed sometime in the previous year.  Our daughter's development - cognitive, emotional, social, gross and fine motor - has been on target, if not advanced, across the board.  She showed NO symptoms of increased ICP ever.  The neurosurgeon, upon discovering the shunt failure and approximately 1cm. of head growth in a year, decided to revise our daughter's subduroperitoneal shunt (Oct., 1996).  On the day of surgery, the nuerosurgeon discovered an opening pressure of 19 and a VP shunt was placed.  Our daughter's CT scans have never shown signs of hydrocephalus or ventricles outside of normal limits - they have historically been on the upper end of normal.  It has been my understanding that a child's head grows nearly into adolescence and wonder if, in order to maintain a balance in pressure, our daughter's ventricles remain on the upper end of normal to compensate for the reduction in extra fluid collections.
  Due to personal reasons, we have recently placed our daughter in another neurosurgeon's care and she is exploring the possibility of removing the VP shunt.  Since the conversion, our daughter has had 2 revisions and daily headaches numbering 7 to 60.  An ICP monitor showed low pressure and an abdominal binder, worn for 4 wks. seemed to help a bit.  Our daughter's neurosurgeon is bothered, however, by the fact that when our daughter's VP shunt malfunctioned twice in the past year, she has shown unmistakable symptoms of increased ICP.  The headahes subsided temporarily after each revision.  Debilitating headaches occured immediately after the conversion in Oct. 1996.  We are considering the possibility of having our daughter's shunt clamped but feel nervous about the risks.  
  We certainly would appreciate a response regarding this matter.  Our little girl did not have any idea what a headache was before her conversion.  She manges to maintain straight A's in second grade, do well in her fifth year of dance class and keep up with her busy social calendar despite her discomfort.  
  Thank you much!
  Lynne
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Dear Lynne,
Your situation is complicated.  Often the best way to determine whether a shunt
is necessary is by taking a symptomatic approach.  If it is determined that
the shunt may not be necessary any more, the shunt may be tied off through
a simple skin incision.  The patient can then be observed in the hospital for
a period of time to be sure symptoms of hydrocephalus do not arise.  This way
if the shunt is still necessary, a second simple procedure to untie the shunt
is performed.  If the shunt is no longer necessary, it can be removed at a
later date.
A second approach would be to place a ventriculostomy catheter while your
daughter is in the hospital.  This catheter measures ICP and could be clamped
while your daughter is under direct observation.  If the ICP rises, the ventriculostomy
catheter can be opened easily to drain CSF.  
These situations can be difficult and frustrating.  Speak with your neurosurgeon
about the options to determine the best one for your daughter.
Good luck.




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