vp shunt for arachnoid cyst

[Dimply]

Dear Dr, My son had his shunt since he was 18 months due to arachnoid cyst. He had severe headaches last month and was told his shunt was blocked and so got his shunt revision surgery done. Before the surgery he had a lumbar punture done to prove that there was high pressure causing the headaches. After the surgery the new shunt pressure was put at 13 (his initial pressure before blockage) but he showed signs of overdrainage - frequent headaches that would go away only after lying down. Now it is set at 18 but now he is having frequent headaches 3-4 times a day sometimes only nausea that would go away on its own without lying down. We also found out that he had tonsillar herniation of 7mm which the ns here is not too worried he said it should go back in after few months and he would get my son to do mri after 6 months. We are due to see the dr after a week. Need your advice of what is to be done.  I was told that his headaches would take a while to settle down, is it true ? He also sometimes complain of pain around his tummy area near the shunt scar. Is there a cause for me to worry ?Thank you so much.

[Dimply]

Dear Dr Sharma,

Thank you for ur reply. Today we had an appmt with the ns and the shunt pressure was adjusted down to 16 and we were asked to monitor the headaches and be back after a week. My NS is not too worried about the tummy pain he said it will settle down on its own. My son had the tummy pain twice in this 1 week. My NS  is confident the new shunt is working well and not blocked. He is also not too worried about the tonsilar herniation. Is it true that tonsilar herniation (in my son's case is 7mm) can go back on its own ? Appreciate your reply. thank you so much.

[Dimply]

Thank you for your reply. shall follow thru with the dr asap. but is it true that tonsilar herniation can go back in on its own ?

[Dr Sharma]

Hi there. It would be better to keep a close check of your child’s intracranial pressure. persistent headaches either due to raised ICP from blocked shunt, or csf leakage due to over drainage, or brain herniation, all cause for a concern. tonsillar herination could cause brainstem paralysis and cessation of spontaneous respiration and vasomotor paralysis. Pain at abdominal site of vp shunt could signal a blockage of the shunt or the peritoneal end abutting skin or irritating against a nerve. Let the doctor treat your kid immediately for raised ICP leading to herniation. Hope this helps. Take care.