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Neurology (Expert Forum)
Ventriculostomy or Shunt?
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Ventriculostomy or Shunt?
by Diana-Womack, Dec 03, 1998 12:00AM
Who is a good candidate for Ventriculostomy? I was born with Hydrocephalus and a meningocele. I had a VP shunt put in that I kept without incident until I was thirteen. At thirteen it was replaced. I am 26 now and know that at some point I will need a revision. It would be wonderful to not need a shunt anymore. I am very interested in ventriculostomy as an option. I have heard that those with congenital Hydrocephalus are not favored for this surgery. I would appreciate any information you could give me.
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Dear Diana,
In patients with an existing shunt, it may be necessary to revise the shunt throughout a lifetime. This is common when pediatric patients reach puberty and outgrow the shunt tubing or when a patient has an infection for some reason. If there are no problems with the shunt it should be left alone.
What you are likely talking about is called a 3rd ventriculostomy. This is a kind of internal shunt that is done using a tool with a camera on the end called a ventriculoscope. The surgeon enters the ventricular system and makes a small hole in the floor of the 3rd ventricle allowing CSF to flow into the spinal CSF spaces. This effectively diverts CSF around the 4th ventricle, a common site of obstruction in patients.
There are many causes for hydrocephalus. In patients with a discrete obstruction in or around the 4th ventricle a 3rd ventriculostomy may be a good option because it avoids the risks associated with shunt hardware. Your meningocele (or myelomeningocele?) is not such a case and it would be doubtful that a 3rd ventriculostomy would help.
Speak to your surgeon about the issues for his opinion in your case to be sure.
Good luck.
