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Updated: Aug 29, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Asymptomatic shunt malfunction detected fortuitously by observation of papilloedema
K Arnell1, E Eriksson, L Olsen
1Department of Paediatric Surgery, University Children's Hospital, Sweden. Kai.Arnell@kirurgi.uu.se
Insights
Shunt malfunction in children can be subtle, with papilledema (swelling of the optic disc) being an early sign of increased intracranial pressure. Regular eye exams are crucial for detecting this condition early.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Ophthalmology
Background:
- Shunt malfunction in hydrocephalus often presents with severe symptoms like headache and vomiting.
- Raised intracranial pressure is a common indicator of shunt issues, typically identified via CT scans.
Purpose of the Study:
- To investigate shunt malfunction in children presenting with subtle symptoms and papilledema.
- To highlight the diagnostic value of ophthalmoscopy in detecting early signs of increased intracranial pressure in shunt-dependent children.
Main Methods:
- Retrospective analysis of six hydrocephalic children (8-14.5 years) with shunt malfunction detected due to papilledema.
- Neurological examinations, computed tomography (CT) scans, and direct intracranial pressure measurements during shunt revision were performed.
Main Results:
- Papilledema was the primary indicator of shunt malfunction in children with minimal or no overt symptoms.
- CT scans showed minimal ventricular dilatation in some cases, and intracranial pressure readings during shunt revision were significantly elevated (25-52 cm H2O).
- Most children experienced visual improvement after shunt revision, but one had persistent visual deficit.
Conclusions:
- Older children with shunt dependence may develop increased intracranial pressure with subtle symptoms and minimal ventricular changes.
- Asymptomatic papilledema can be a critical sign of shunt malfunction, emphasizing the importance of routine ophthalmoscopy in monitoring these patients.
Abstract:
Significant shunt malfunction is nearly always followed by headache, nausea, vomiting, lethargy and/or visual disturbances. In many cases there are also signs of raised intracranial pressure on computed tomography (CT). In six hydrocephalic, shunt dependent children (8-14,5 years) with no or slight symptoms shunt malfunction was detected because of papilloedema. The oedema was detected in three children at routine check up, in two at regular visual check up and in one at an ophthalmological examination because of slight headache. At neurological examination five had no new symptoms, but one was ataxic. In five patients a CT scan was done, three showed slight ventricular dilatation. Splayed sutures were found in two children. At shunt revision the measured intracranial pressure was increased, varying between 25-52 cm H(2)O. In five children the oedema disappeared after shunt-revision without any visual reduction, but in one the visual deficit did not improve. Older children can have shunt malfunction leading to increased intracranial pressure, with no or discrete symptoms and no obvious ventricular dilatation but with asymptomatic papilloedema. Ophthalmoscopy can therefore be of great value at routine check up in these children.
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