Cerebrospinal Fluid Shunts

The shunting of cerebrospinal fluid (CSF) was first described in 1895, but it was not until the 1950s that shunting ventricular CSF became a routine procedure. 12 Hydrocephalus has an incidence of 3 cases per 1000 live births. Mechanical shunting is the primary treatment as there is usually no alternative corrective surgical or medical therapy for this disorder. Each year there are approximately 18,000 CSF shunts inserted, making it the most common pediatric neurosurgical procedure performed in the United States.1 The CSF shunt is also the neurosurgical procedure with the highest incidence of postoperative complications. 12

Many types of CSF shunt systems exist. Most systems consist of three components beginning with a silastic tube passed into the ventricle via a burr hole. This tubing is tunneled subcutaneously to a valve chamber. The valve chamber, the second component, establishes a pressure gradient that ensures drainage of fluid away from the ventricle. The valve chamber, or in some cases a separate reservoir, allows access to the shunt system for patency testing, pressure measurement, CSF sampling, medication injection (e.g., chemotherapy, antibiotics), or contrast administration. Distal tubing, which is the third component, connects the valve chamber to a drainage point. The most common drainage site is the peritoneal cavity. Other drainage sites include the right atrium, gallbladder, pleural cavity, and ureter.

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