Hydrocephalus shunts By: Alex Gray BME 281

What is Hydrocephalus? Neurological disorder where an excess of cerebrospinal fluid (CSF) builds up in the brain causing increased intracranial pressure (ICP) Lateral ventricles produce CSF that is filtered through brain and ventricles to be reabsorbed, but is obstructed and/or not reabsorbed building up pressure

Causes of Hydrocephalus Obstruction of CSF flow Cysts Tumors Blood clots Subarachnoid hemorrhage Aneurysmal bleeding Lack of reabsorption of CSF Overproduction of CSF https://en.wikipedia.org/wiki/Hydrocephalus

Side effects of hydrocephalus Headaches Seizures Vomiting Double vision Impaired cognitive function Memory loss Short term memory problems http://www.emsworld.com/article/11102879/can-hydrocephalus-cause-a-seizure

History of hydrocephalus treatment: 1825- various papers describing CSF flow and brain physiology 1891- Lumbar puncture was described as a treatment for hydrocephalus 1908- "Balkenstich Method” – hole made in corpus callosum to drain into subdural spaces 1950’s- radioactive tracers to better understand actual flow of CSF 1952- shunt technology begins in its infancy using ball and spring valve http://www.hydroassoc.org/shunt-systems/

Current Shunt technology Three main components Proximal catheter tubing Valve and reservoir Distal catheter Tubing Various pressure setting based on patients needs Low, medium, high Many utilize ball and spring valve to regulate flow https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765598/pdf/v073p00i17.pdf

Different types of shunts Ventriculoatrial (VA) Ventriculoplueral (VPL) Ventriculoperitoneal (VP)- Most common Gravity assisted valve (GAV) Programmable valve http://www.medscape.com/viewarticle/558974_2 http://auburnspine.com/disorder/brain_nph_treatment.html

Limitations Failure rates as high as 40% in first two years Obstruction Infection within the first 2 years 10-15% Over-drainage Require consistent revisions based on varying flow rates and pressure Unpredictable and difficult to survey changing conditions

Future Technology Smart shunt technology Self correcting shunt Ability to record and transmit data from persons brain Material science advances to lower infection rate and obstruction rate Different tubing and valve mechanisms http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3642745/

Questions?

Bibliography Lifshutz, Jason I., and Walter D. Johnson. "History of Hydrocephalus and Its Treatments." Neurosurgical FOCUS 11.2 (2001): 1-5. Web. http://www.medscape.com/viewarticle/405733 "Hydrocephalus." Wikipedia. Wikimedia Foundation, n.d. Web. 27 Sept. 2016. https://en.wikipedia.org/wiki/Hydrocephalus Interactive, Rails. "Disorders Brain Treatment of Normal Pressure Hydrocephalus." Auburn Spine and Neurosurgery Center. Auburn Spine and Neurology Center, n.d. Web. 27 Sept. 2016. http://auburnspine.com/disorder/brain_nph_treatment.html Lee, Won-Chul, Dae-Hee Seo, Il-Seung Choe, Sung-Choon Park, Young-Soo Ha, and Kyu Chang Lee. "A Comparative Result of Ventriculoperitoneal Shunt, Focusing Mainly on Gravity-Assisted Valve and Programmable Valve." J Korean Neurosurg Soc Journal of Korean Neurosurgical Society 48.3 (2010): 251. Web. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966728/ Browd, Samuelr, Barryr Lutz, and Pranav Venkataraman. "New and Improved Ways to Treat Hydrocephalus: Pursuit of a Smart Shunt." Surgical Neurology International Surg Neurol Int 4.2 (2013): 38. Web. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3642745/ Pople, I. "HYDROCEPHALUS AND SHUNTS: WHAT THE NEUROLOGIST SHOULD KNOW." Journal of Neurology, Neurosurgery, and Psychiatry. BMJ Group, Sept. 2002. Web. 27 Sept. 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765598/pdf/v073p00i17.pdf "Shunt Systems." Hydrocephalus Association. N.p., n.d. Web. 27 Sept. 2016. http://www.hydroassoc.org/shunt-systems/ Allanach, Simon. "What Is Hydrocephalus?" What Is Hydrocephalus? N.p., n.d. Web. 27 Sept. 2016. http://hydrocephalus.allanach.dk/hydrocephalus "Medscape Log In." Medscape Log In. N.p., n.d. Web. 27 Sept. 2016. By Understanding Possible Shunt Complications, You Can Direct Your Care to Assess the Specific Problem, Whether It Be Initiating Treatment for an Infection or Recognizing the Need for Transport for a Possible Break in the Shunt Due to Rough Physical Activity or Trauma. As EMS Providers, We Encounter a Variety of Special Populations. Having a Little Insight into Them Will Allay Some of Our Anxiety That Comes from the Unknown. Next Time You Encounter a Situation in Which Our EMS Crew Did, Step Back, Take a Breath and Do What You Do Best-care for Those in Their Time of Need. "Can Hydrocephalus Cause a Seizure? | EMSWorld.com." EMSWorld.com. N.p., n.d. Web. 27 Sept. 2016. http://www.emsworld.com/article/11102879/can-hydrocephalus-cause-a-seizure