====== Ventriculoperitoneal Shunt Management ====== **Juan Sales-Llopis** ''Neurosurgery Department, General University Hospital of Alicante, Spain'' ---- ---- {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1dMOQb-H62FxJqFGFDR1hlrq5A5UC4hVJPyiGQyU6SIyzwQYM6/?limit=15&utm_campaign=pubmed-2&fc=20250705090417}} ---- ---- ===== 🧪 Perioperative Considerations ===== * Pre-op imaging (CT/MRI) to evaluate ventricular anatomy * Antibiotic prophylaxis * Valve selection based on age, pathology, and revision history * Intraoperative confirmation of ventricular catheter placement (navigation or ultrasound if complex) ---- ===== 📊 Postoperative Monitoring ===== * **Immediate CT scan** to confirm catheter position, rule out pneumocephalus or hemorrhage * Clinical improvement in hydrocephalus-related symptoms * Wound inspection and signs of infection * **Shunt series X-rays** if malfunction is suspected ---- ===== 🧭 Diagnostic Tools in Suspected Failure ===== * **CT scan**: ventricle size changes (enlargement or slit ventricles) * **Shunt series**: assess continuity and positioning of components * **Valve interrogation** with programming device (if applicable) * **Radionuclide shunt study** for functional assessment * **Reservoir tap**: opening pressure, CSF clarity and cell count ---- ===== 🔄 Management of Shunt Failure ===== * **Infection or obstruction** → full shunt system removal often necessary * **Isolated component failure** → partial revision may be sufficient * **Infection**: remove shunt → place temporary EVD → antibiotics → delayed reimplantation * Consider **ETV** as alternative in selected cases (e.g., aqueductal stenosis) ---- ===== 🧭 Long-Term Follow-Up ===== * Clinical assessment: gait, cognition, urinary function * Periodic neuroimaging as indicated * Valve pressure adjustments in programmable systems * Patient/caregiver education on warning signs of dysfunction ===== Letters to the Editor ===== In a [[Letter to the Editor]] Lu et al. published in the [[Journal of Neurosurgery]] to discuss [[ventriculoperitoneal shunt management]] strategies for [[discharge]]d patients ((Lu J, Zhou J, Li Y. Letter to the Editor. Management of patients discharged from the hospital after VPS surgery. J Neurosurg. 2025 Jul 4:1-2. doi: 10.3171/2025.4.JNS25484. Epub ahead of print. PMID: 40614281.)). ===== Critical Appraisal ===== - **Strengths:** - Highlights a clinically important gap—post-discharge VPS care. - Sparks important discussion on outpatient monitoring and follow-up protocols. - **Limitations:** - Absence of abstract/data: no study design, patient numbers, follow-up length or outcomes described. - Lacks novel evidence—appears more observational or comment-based rather than presenting new data. - Limited generalizability: single-center or experiential letter format. - Without details, it’s impossible to assess validity or applicability. - **Verdict:** While raising practical concerns is commendable, the letter’s value is minimal without supporting data. It should not change practice but may prompt more detailed studies or guidelines. ===== Takeaway for Practicing Neurosurgeon ===== - Be vigilant about VPS patients after discharge—consider structured follow-up. - Recognize the need for standardized outpatient care (e.g., home nursing, telehealth check-ins, valve pressure reviews). - Use this letter as a prompt—not as evidence to alter protocols yet. ===== Bottom Line (Score: 3/10) ===== - **Score:** 3/10 – Raises awareness but lacks [[data]], [[methodology]], and actionable insights. - **Bottom Line:** This letter draws attention to an under-addressed issue—post-discharge management of VPS patients—but in its current form, offers more suggestion than evidence. A useful conversation starter, but not a practice-changer. ===== Categories & Tags ===== - **WordPress Categories:** Letters, Neurosurgery, VPS, Patient Management - **Tags:** ventriculoperitoneal shunt, post-discharge care, outpatient monitoring, neurosurgery letter