Different types of CSF shunts vary mostly by the location of the distal tubing and the type of reservoir or valve system The choice of CSF shunt type and the method of placement (endoscopically or nonendoscopically) depend on the individual patient’s anatomy and cause of hydrocephalus and the experiences and preferences of the neurosurgeon performing the procedure Commonly, the patient or caregiver knows the location and type of shunt and is able to provide details regarding prior shunt placement and problems Palpation of the hardware and plain radiographs may be used to acquire more information regarding the specific location of the shunt components Most CSF shunts have the following components: (1) proximal shunt tubing, (2) reservoir system, and (3) distal shunt tubing ( Fig 135.3 ) Occasionally, the system will not contain a reservoir and instead will have a one-way valve The proximal shunt tubing has a fenestrated tip that is usually located in the ventricle but may also be located inside a communicating cyst or in the lumbar subarachnoid space This tip allows free passage of CSF into the shunt system unless it becomes occluded More than one proximal catheter may be present if multiple, noncommunicating areas of the brain require shunting The reservoir system consists of one or two “domes” or “bubbles.” Reservoirs may be placed directly over or slightly distal to the burr hole This information is crucial when emergent access to the burr hole is needed The distal shunt tubing leads from the reservoir unit to a part of the body that can accept the drained CSF, usually the peritoneum The distal tubing may also be located in the vascular system or pleural cavity Ventricular–atrial shunts are less commonly inserted because of the serious infectious complications that have occurred with these types of shunts, but may be necessary due to severe scarring in the peritoneum All modern shunt tubing is made of 1/8-in diameter Silastic elastomer, which causes minimal omental reaction and is resistant to cracking