ventriculoperitoneal (VP) shunt
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Introduction
An artificial passage (shunt) from the cerebral ventricle(s) into the peritoneum.
Indications
Diagnostic procedures
- shunt malfunction or suboptimal function:
- if programmable valve was placed, lowering the pressure setting may be indicated[2]
- lumbar tap tests
- CSF infusion tests[3]
Radiology
Complications
- shunt infection
- shunt occlusion
- most shunt complications occur within 1st year, but risk is long-term[4]
Management
- shunt infection
- bacterial meningitis
- vancomycin plus ceftazidime, cefepime or meropenem[5]
- gram-negative coverage for Pseudomonas aeruginosa & Acinetobacter baumannii[5]
- intravenous & intraventricular antimicrobial therapy (usually vancomycin or gentamicin) may be required to eradicate infection, especially in patients with multidrug-resistant gram-negative bacilli (e.g., Acinetobacter baumannii)
- removal of infected external or internal ventricular catheter
- vancomycin plus ceftazidime, cefepime or meropenem[5]
- bacterial meningitis
More general terms
References
- ↑ 1.0 1.1 UpToDate Online version 17.1
- ↑ 2.0 2.1 Vanneste JA Diagnosis and management of normal pressure hydrocephalus J Neurol 2000, 247:5 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10701891
- ↑ 3.0 3.1 Malm J et al, CSF outflow resistance as a predictor of shunt function. A long-term study Acta Neurol Scand 2004, 110:154 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15285771
- ↑ 4.0 4.1 Pujari S et al, Normal pressure hydrocephalus: long-term outcome after shunt surgery. J Neurol Neurosurg Psychiatry 2008, 79:1282 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18356257
- ↑ 5.0 5.1 5.2 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015