الفهرس 
PHYSIOLOGY OF CEREBROSPINAL FLUIDOnly 14 pages are availabe for public view
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Abstract
Hydrocephalus is defined in pathophysiological terms as an imbalance of the CSF formation and absorption of sufficient magnitude to produce a net accumulation of fluid within the cerebral ventricles, this excess in fluid usually leads to elevation of the intracranial pressure.
In patients with an incurable cause of hydrocephalus, CSF diversionary procedure to a structure or area where it can be absorbed or excreted should be performed.
Three different shunt systems were commonly used for diversion of CSF: ventriculatrial (VA), venticuloperitoneal (VP) and lumboperitoneal (LP).
Recent studies show that VP shunting has become the initial procedure of choice when treating hydrocephalus, particularly in the neonate.
Despite the proven effectiveness of ventriculoperitoneal shunts in treating hydrocephalus, complications continue to occur with distressing frequency.
Shunt complications may occur: within the abdomen, intracranial, or along the shunt tract.
Abdominal complications may be encountered in 5% to 25% of pediateric patient.
Abdominal complications can be divided into: biological complications including (shunt infection, abdominal CSF pseudocyst, and CSF ascitis), mechanical complications including (malposition of the catheter, shortening of the catheter, and disconnection and migration), and complications involving abdominal structures including (intestinal obstruction, bowel perforation, pyogenic liver abcess, CSF hydrocele, hernia, and abdominal metastasis).
Intracranial complications includes: proximal shunt obstruction, overdrainage, extraaxial fluid collection, slit-ventricle syndrome, and seizures.
Complications along the tract of shunt includes: thoracic complications (hydrothorax and pneumothorax), migration of catheter into the heart, and neck haematoma.
Infection is the commonest complication of VP shunt procedures and may predispose to most of the other complications. Infection may occur at the time of shunt placement, but more typically is acquired later. Any type of organisms can be responsible, but Staphylococcus species are the most common.
Treatment of patients with shunt infection is done by shunt removal, CSF drainage and combined intravenous and intraventricular antibiotics according to culture and sensitivity. Shunt insertion is done after negative three successive CSF cultures and lower CSF protein level.
On conclusion, venriculoperitoneal shunts have many potential complications. Many are prone to failure, and these problems make a challenge to clinical research efforts and elegant shunt designs. Therefore continuous careful follow up of the hydrocephalic patient with ventriculoperitoneal shunt and prompt management of complications are required to optimize the quality of life for these patients.