1. Hydrocephalus shunts
By: Alex Gray
BME 281

2. 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

3. Causes of Hydrocephalus
Obstruction of CSF flow
Cysts
Tumors
Blood clots
Subarachnoid hemorrhage
Aneurysmal bleeding
Lack of reabsorption of CSF
Overproduction of CSF

4. Side effects of hydrocephalus
Headaches
Seizures
Vomiting
Double vision
Impaired cognitive function
Memory loss
Short term memory problems

5. 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

6. 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

7. Different types of shunts
Ventriculoatrial (VA)
Ventriculoplueral (VPL)
Ventriculoperitoneal (VP)- Most common
Gravity assisted valve (GAV)
Programmable valve

8. 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

9. 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

10. Questions?

11. Bibliography
Lifshutz, Jason I., and Walter D. Johnson. "History of Hydrocephalus and Its Treatments." Neurosurgical FOCUS 11.2 (2001): 1-5. Web.
"Hydrocephalus." Wikipedia. Wikimedia Foundation, n.d. Web. 27 Sept
Interactive, Rails. "Disorders Brain Treatment of Normal Pressure Hydrocephalus." Auburn Spine and Neurosurgery Center. Auburn Spine and Neurology Center, n.d. Web. 27 Sept
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.
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.
Pople, I. "HYDROCEPHALUS AND SHUNTS: WHAT THE NEUROLOGIST SHOULD KNOW." Journal of Neurology, Neurosurgery, and Psychiatry. BMJ Group, Sept Web. 27 Sept
"Shunt Systems." Hydrocephalus Association. N.p., n.d. Web. 27 Sept
Allanach, Simon. "What Is Hydrocephalus?" What Is Hydrocephalus? N.p., n.d. Web. 27 Sept
"Medscape Log In." Medscape Log In. N.p., n.d. Web. 27 Sept
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