- Standard neurosurgical pre-assessment applies
- Specific questioning relating to ICP:
- Alterations in conscious level
- New or changed seizure activity
- Medications e.g. anti-convulsants, acetazolamide, furosemide
- Establish whether there are:
- Coalescing comorbidities e.g. congenital cardiac disease
- Sequelae of neurological dysfunction e.g. recurrent respiratory infections
Shunt Surgery
Shunt Surgery
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- The most common shunt procedure is insertion of a ventriculoperitoneal (VP) shunt for hydrocephalus, which drains CSF from a lateral ventricle to the peritoneal cavity
- Other shunts include:
- Ventriculo-pleural
- Ventriculo-atrial
- Lumbar-peritoneal
- Is typically performed as an elective procedure, without concerns about acutely raised ICP
- A high proportion of cases will be in paediatric patients
Perioperative management of the patient undergoing shunt surgery
Monitoring and access
- AAGBI
- Invasive arterial monitoring not required unless other indications
Anaesthetic technique
- Patient positioning is usually lateral, but may instead be prone depending on exact nature of procedure
- I&V preferred due to limited access
- The tunnelling process is very stimulating, particularly the distal end, but post-operative pain is not significant
- ICP is often chronically raised
- Rapid shifts in CSF can lead to intracranial haemorrhage
Patients with existing shunts
- No contra-indication to spinal anaesthesia in patients with existing VP shunts, though often avoided due to concerns re: shunt contamination/CNS infection
- Laparoscopy is not absolutely contra-indicated by limiting pressure and duration of pneumoperitoneum and observing CSF drainage during the procedure is advised
Care bundle
- No additional antibiotics required; typically ineffective CSF penetration anyway
- Temperature management as standard
- Post-operative pain is mild/moderate; regular simple analgesia with PRN opioids usually suffices