Creation of shunt; ventriculo-atrial, -jugular, -auricular
CPT4 code
Name of the Procedure:
Creation of Shunt; Ventriculo-Atrial, Ventriculo-Jugular, Ventriculo-Auricular.
Summary
This procedure involves the surgical creation of a shunt to redirect cerebrospinal fluid (CSF) from the brain's ventricles to either the atrium of the heart, the jugular vein, or the auricle (a part of the ear). It is primarily used to treat hydrocephalus, a condition characterized by excessive accumulation of CSF in the brain.
Purpose
The primary purpose of the procedure is to relieve pressure on the brain due to excess cerebrospinal fluid. The goal is to reduce symptoms such as headaches, nausea, vomiting, and potential brain damage. By creating a pathway for the fluid to be absorbed by another part of the body, normal brain function can be restored or maintained.
Indications
- Persistent and symptomatic hydrocephalus.
- Increased intracranial pressure not responsive to other treatments.
- Congenital or acquired conditions leading to CSF accumulation.
Preparation
- Pre-procedure fasting (typically 6-12 hours) to prepare for anesthesia.
- Adjustment of certain medications, as advised by the healthcare provider.
- Diagnostic imaging tests such as MRI or CT scans to assess the condition and plan the procedure.
Procedure Description
- Patient is placed under general anesthesia.
- An incision is made on the scalp and a small hole is drilled into the skull.
- A catheter is inserted into the ventricular system of the brain.
- The other end of the catheter is tunneled under the skin and connected to a second catheter that is inserted into the chosen drainage site (atrium of the heart, jugular vein, or auricle).
The shunt system is tested to ensure proper flow of CSF, and incisions are closed with sutures.
Tools and Equipment:
- Neurosurgical instruments.
- Catheters and shunt valves.
- Imaging technology for guidance.
Duration
The procedure typically takes 1 to 2 hours.
Setting
Performed in a hospital operating room under sterile conditions.
Personnel
- Neurosurgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Shunt malfunction or blockage
- Bleeding or hemorrhage
- Overdrainage or underdrainage of CSF
- Allergic reaction to anesthesia
Benefits
- Relief of symptoms associated with hydrocephalus.
- Prevention of long-term brain damage.
- Improved quality of life and daily functioning.
Recovery
- Hospital stay for monitoring (usually a few days).
- Instructions on incision care and activity limitations.
- Gradual return to normal activities over several weeks.
- Follow-up appointments to monitor shunt function.
Alternatives
- Endoscopic third ventriculostomy (ETV)
- Medical management with medications (though less effective)
- Continuous lumbar puncture (temporary and less practical)
Patient Experience
- Patients may experience discomfort and need pain management post-surgery.
- Weakness, fatigue, or mild headache for several days post-procedure.
- Gradual improvement in symptoms as the body adjusts to the shunt.
Pain management and comfort measures, including medication and assistance with mobility, will be provided to ease recovery.