Shunt Surgery for Normal Pressure Hydrocephalus

NYU Langone specialists can surgically implant a shunt system to alleviate the stretching of the brain caused by normal pressure hydrocephalus. A shunt is a small device placed in the brain that drains cerebrospinal fluid away from the brain and into the body, where it can be absorbed.

Before surgery your doctor evaluates you to be certain that any other medical conditions are well controlled. A physiatrist, or doctor who specializes in rehabilitation medicine, also performs an evaluation to determine how much therapy you may need after surgery.

During shunt surgery, a neurosurgeon makes a small incision in either the front or the back of the skull and places one end of a flexible tube called a ventricular catheter into the fluid cavity in the center of the brain. The other end of the catheter is tunneled under the skin to the abdominal cavity, a heart chamber, or the lung area, where spinal fluid can drain and be absorbed.

A surgeon decides where the catheter ends based on the needs of each individual. A valve in the shunt regulates the flow of spinal fluid to prevent too little or too much drainage.

The surgery requires general anesthesia, and usually takes 30 minutes to one hour.

Recovering from Surgery

You remain in the hospital under careful neurological observation for the first 24 hours after surgery. Most people are able to leave the hospital the next day, although some may need a longer stay.

Depending upon a person’s health before surgery, some people may be transferred to NYU Langone’s Rusk Rehabilitation or another rehabilitation facility for 7 to 10 days of intensive physical therapy.

Once you are home, you follow up with your neurosurgeon within a couple of weeks to ensure the shunt is working properly.

About six to eight weeks after surgery, your doctor orders an MRI scan to check on the size of the ventricles and be certain that there are no other problems, such as bleeding. You follow up with your care team, which may include your neurologist and neurosurgeon, every few months over the course of a year to make sure your symptoms have subsided and that the shunt is operating correctly.

A shunt is permanent, but because it can malfunction, it may have to be repaired or replaced throughout a person’s life. Other rare but serious problems can include infection and bleeding, usually within the first few weeks after the surgery.

Most problems associated with shunt implantation, such as an obstruction along the shunt tube, occur weeks or even years after the surgery. Regular checkups with a neurologist or neurosurgeon are necessary so that doctors can look for any complications or shunt malfunction. NYU Langone doctors also educate people who have normal pressure hydrocephalus and their families on how to observe whether a shunt is working properly.

Your doctor may recommend physical therapy, occupational therapy—a treatment that helps people participate in the things they want and need to do in their daily lives—or other outpatient rehabilitation options after surgery to help you regain mobility and independence.

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