THÔNG TIN TÀI LIỆU
allergy Eventually, antibiotic therapy may be narrowed on the basis of culture and sensitivity results of the shunt fluid Overdrainage Occasionally, children with CSF shunts experience symptoms related to the system working too well, resulting in low ICP Such overshunting is more common in infants who have had initial shunting before months of age One consequence is the slit ventricle syndrome, in which the ventricles collapse around the proximal catheter port and block further drainage The best means of diagnosing intracranial hypotension is the patient’s history rather than physical examination or radiographic analysis Young infants may exhibit sunken fontanels, microcephaly, or overriding parietal bones Older children may exhibit intermittent symptoms of headache, nausea, vomiting, and lethargy The drainage of CSF shunts increases when the patient is upright and decreases when supine In contrast to the classic timing of symptoms related to increased ICP, patients with intracranial hypotension are often worse when in the standing position or after they are awake for several hours Lying supine for a few hours tends to relieve symptoms of slit ventricle syndrome Many patients with CSF shunts have CT scans that reveal small ventricles; however, only a small proportion of these patients have slit ventricle syndrome Therefore, the CT scan is best used to differentiate between shunt malfunction and other causes of symptoms rather than to diagnose an overdrainage problem Chronic or recurrent episodes of slit ventricle syndrome can be addressed surgically by upgrading the resistance of the valve or by insertion of an antisiphon device Oral analgesics may be helpful in managing mild cases Other Complications Other complications related to CSF shunts deserve mention The most common of these complications is a benign postoperative leakage of CSF around the proximal shunt tubing into the subgaleal space around the reservoir The resulting extracranial fluid collection resolves spontaneously, so drainage of this fluid should be avoided In non-postoperative patients, a new extracranial fluid collection can suggest shunt malfunction, as the CSF takes the newest “path of least resistance.” Patients with CSF shunts have an increased risk of seizures compared with the general population These seizures often begin years after shunt placement and are caused by epileptogenic scars They are more common in patients with other
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