Shunt Placement to Treat Normal Pressure Hydrocephalus
While NPH cannot be cured, many people find relief through the surgical placement of a shunt, a thin tube that routes excess fluid from the brain to another area of the body. Because shunt placement is a lifelong treatment for NPH, team members confer to ensure a correct diagnosis is made and that a patient may truly benefit from a shunt. When a patient is correctly diagnosed with NPH, a shunt can greatly improve his or her quality of life.
Improve Symptoms of NPH
A shunt is the only effective treatment for NPH. The goal of shunt placement is to improve the three major symptoms of NPH:
- Urinary incontinence
- Difficulty walking
About 30 percent to 50 percent of patients with idiopathic NPH (no known cause) improve after receiving a shunt. About 50 percent to 70 percent of patients with secondary NPH (related to another brain disorder) improve with a shunt.
The shunt is implanted into one of the ventricles of the brain. The shunt consists of a small tube called a catheter and a valve device that regulates the rate of fluid drainage. The shunt is tunneled under the skin to the drainage site.
Ventriculoperitoneal (VP) Shunt
The most common type of shunt is a ventriculoperitoneal (VP) shunt, which drain excess CSF from the ventricles to the abdominal or peritoneal cavity. There are two types of shunts — non-programmable and programmable. The programmable type has valves that allow the shunt to be adjusted with a magnetic device after surgery to increase or decrease the drainage rate of the shunt. The shunt used for treating NPH usually remains in the brain permanently.
While shunts do not work for every person with NPH, many people experience symptom relief. The shunt allows the fluid to drain out of the brain, which prevents the ventricles from enlarging. This may help a patient walk better, regain bladder control and think more clearly. A successful shunt placement tends to help more with walking and bladder control than with dementia.
Follow-Up Care After Shunt Placement is Important
Regular follow-up care is important to identify any changes that could indicate problems with the shunt. Complications may include valve malfunction or catheter obstruction in the shunt system, or physical complications related to fluid drainage. These include:
- Subdural hygroma, a collection of cerebrospinal fluid beneath the outermost membrane of the brain
- Subdural hematoma, a collection of blood on the surface of the brain
- Headache associated with over-draining of cerebrospinal fluid
Other risks include those related to shunt placement, such as catheter malposition, intracerebral hematoma (bleeding within the brain) and shunt infection.
For patients with NPH who are not candidates for surgery, treatment may include measures to:
- Relieve mood and behavioral problems
- Cope with physical problems (incontinence and walking difficulties)
- Maximize physical, mental and social functioning.