shunt_underdrainage

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shunt_underdrainage [2021/04/10 12:06]
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-The main reasons for [[shunt revision]] were [[shunt underdrainage]] and [[shunt infection]], but [[shunt overdrainage]] and mechanical failure continue to pose problems. 
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-General information 
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-The shunt malfunction rate is ≈ 17% during the first year of placement in the pediatric population.  
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-Etiologies 
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-May be due to one or a number of the following:  
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-1. blockage (occlusion) 
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-a) possible causes of occlusion: 
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-● proximal obstruction by choroid plexus 
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-● the buildup of proteinaceous accretions 
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-● blood 
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-● cells (inflammatory or tumor) 
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-● secondary to infection  
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-b) site of blockage 
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-● blockage of the ventricular end (most common): usually by choroid plexus, may also be due to glial adhesions, intraventricular blood 
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-● blockage of intermediate hardware (valves, connectors, etc.; tumor filters may become obstructed by tumor cells, antisiphon devices may close due to variable overlying subcutaneous tissue pressures) 
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-● blocked distal end, also see VP shunt  
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-2. [[disconnection]], kinking or breakage of the system at any point: with age, silicone elastomers used in 
-catheters calcify and break down, and become more rigid and fragile and more likely to adhere to the subcutaneous tissue. 
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-Barium impregnation may accelerate this process. Tube fractures often occur near the clavicle, presumably due to the increased motion there