Pediatric Brain Shunts

What is a brain shunt?

A brain shunt is a device that drains extra cerebrospinal fluid (CSF) from the brain. CSF is the colorless fluid that cushions the brain and spinal cord, protecting them from injury.

Normally, CSF is produced in the brain, flows through and around the brain and spinal cord, and is then reabsorbed into the bloodstream. When this process doesn't work as it should, CSF can build up in the ventricles (fluid-filled spaces in the brain), resulting in a condition called hydrocephalus. Hydrocephalus can cause harmful pressure on the brain that, left untreated, may lead to brain damage and even death. Brain shunts relieve the pressure.

What do brain shunts treat?

A brain shunt is a common surgical treatment for both congenital hydrocephalus (hydrocephalus that's present at birth) and acquired hydrocephalus (hydrocephalus that develops after birth). Shunts can also be used to treat babies with severe intraventricular hemorrhage, or bleeding inside the brain.

How do brain shunts work?

A brain shunt typically has two catheters (thin, flexible tubes) and a valve. One catheter drains excess fluid from the brain; the other transports the fluid somewhere else in the body to be reabsorbed. The valve controls how much fluid leaves the brain. All three parts are implanted inside the body.

When the pressure in your child's head reaches a specific level, the valve opens to allow CSF to pass. There are two types of brain shunt valves:

• Fixed valve. This type allows CSF to drain whenever the pressure passes a certain threshold.
• Adjustable valve. While this valve is also set to a specific pressure, your child's doctor can change the setting.

There are different types of brain shunts available, but most children with hydrocephalus get a ventriculoperitoneal (VP) shunt. This shunt moves fluid from the brain to the belly area (the peritoneal cavity), where it can be absorbed.

Procedure for brain shunt placement

Placing a brain shunt requires surgery. Most brain shunt surgeries take one to two hours.

Before surgery, an area of your child's head may be shaved. An anesthesiologist will put your child under general anesthesia (completely asleep), so they won't feel any pain.

Inside the operating room, the pediatric neurosurgeon will make a small incision on your child's head and abdomen, as well as a small hole in the skull. The surgeon will then implant the three parts of the shunt:

• Inflow catheter. The surgeon will place one end of this catheter in a brain ventricle.
• Outflow catheter. For a VP shunt, this catheter is placed to run from behind the ear down to the abdomen. The surgeon may need to make a few more small incisions in order to pass the catheter under the skin.
• Valve. The surgeon will connect both catheters to the valve, which is usually placed behind the ear.

Finally, the surgeon will close the incisions with stitches or staples.

Recovery from brain shunt surgery

The pediatric neurosurgery team will talk to your family about caring for your child's shunt at home. Their instructions may include giving your child medications to relieve pain or prevent infection.

Stiches or staples will be removed about one to two weeks after the surgery. Until then, your child shouldn't put their head under the shower or wash their hair. Sponge baths are fine. Avoid soaking the incisions in water until the skin has fully healed.

Follow-up care for brain shunts

Most patients with a brain shunt will have it for life. Because shunts can malfunction, your child will need regular checkups. Some children need surgeries to repair or replace shunts that malfunction. Some kids outgrow their shunt over time.

Signs that a shunt isn't working properly include:

• Return of hydrocephalus symptoms
• Nausea or vomiting
• Swollen belly
• Headache
• Sensitivity to light or double vision
• Dizziness
• Sore neck or shoulder muscles
• Seizures
• Fever
• Fatigue
• Redness or tenderness in the area of the shunt
• Loss of developmental skills
• Decline in school performance
• Increased fussiness or irritability

If you notice signs that could indicate shunt failure, contact your child's pediatric neurosurgeon right away.

Many children with hydrocephalus benefit from additional services, such as educational support and developmental therapy. Ask your child's care team for information.

Children with brain shunts can do almost anything that kids without shunts can do, including swimming, airplane travel, and other childhood or family activities. Many patients go on to enjoy full, active lives.