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Baby born with hydrocehpalus. Has fluid around the valve of the shunt. MRI and X-ray normal. Cause?

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Neurologist, Surgical
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My baby is 4 months old born with hydrocehpalus. has fluid buildup around the valve of her shunt. how does the fluid buildup happen. is there too much fluid for the shunt. is the shunt working too slowly? ( its not a programmable shunt) is water leaking out of the shunt? is there a way to drain the fluid around the shunt? what is the purpose of the valve on the shunt? i saw my dr. pressing it when today when i went to check out the shunt. what is supposed to happen when you press it? there is a lot of buildup around the valve. not a little. i did mri today and exray and dr said everything looks ok.
Posted Sat, 27 Jul 2013 in Brain and Spine
 
 
Answered by Dr. Shivakumar S. Kupanur 1 hour later
Hello.

Thanks for posting your query.

Peritubal (around the tube) fluid collection happens due to many reason. E.g. increased intracranial pressure, shunt block, etc.

Best way to monitor the shunt function is clinically. If the child is improving symptomatically and the hydrocephalus is resolving, that shows shunt is functioning well.

If the shunt is not draining properly, child will not show clinical improvement. You have not mentioned about your child's progress.

Another thing is that there is a chamber in the shunt which looks like fluid collection in MRI or X-ray because the shadow will be opaque. Valve is to prevent the back flow. Your doctor has checked the refilling of shunt chamber by pressing it. If the chamber is refilling well it means shunt is working fine.

In case the fluid is actually collected, revision of shunt is the only answer. But, as per the information you have provided (except your child's clinical findings) I feel the shunt is working nicely, otherwise your doctor would have informed you about it.

I hope, this answers your query. I will be available to answer the follow up queries if any.

Wishing your baby a speedy recovery.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Baby born with hydrocehpalus. Has fluid around the valve of the shunt. MRI and X-ray normal. Cause? 17 hours later
what happens when there is fluid collection? does fluid come out of the shunt under the skin? how does it come out? are there holes in the shunt? is it coming out from the hole in the skull thats made when the shunt is put in?
 
 
Answered by Dr. Shivakumar S. Kupanur 18 hours later
Hello again.

I can understand your anxiety regarding your child's health. But, if your doctor after assessing says that results are fine, then the shunt is working properly.

1. If the collection of fluid is small, it gets absorbed by itself and does not cause serious consequences. But, if the collection is more and intense, patient can worsen and can become drowsy.

2 and 3. Yes, fluid can come out of the shunt under the skin. Fluid leak is peritubal i.e. around the tube.

4. There are holes in the shunt, but it is within the skull and within the cavity of the brain called ventricle and not outside the skull.

5. Yes, the fluid comes out through the hole made for the shunt entry around the tube.

I hope, this answers your query.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Baby born with hydrocehpalus. Has fluid around the valve of the shunt. MRI and X-ray normal. Cause? 5 hours later
did the doctor make a too big whole in the skull when he placed the shunt. is it gonna grow back to fit the shunt?
Thanks for your clear and detailed anwers.
 
 
Answered by Dr. Shivakumar S. Kupanur 4 hours later
Hello.

Burr hole size is usually standard. Tube is plugged with brain tissue and the overlying dura mater as it passes through the brain tissue.

Tubal leak is around the tube. Size of the burr hole does not matter. What matters is puncture site at brain tissue for the leak to occur.

Usually healing takes place over the period if fluid leak is not there or minimal. If the leak is more, shunt revision is the only treatment.

I don't have the opportunity to see the patient, so it is difficult for me to comment exactly. But, I gave you the overview of treatment modality.

I hope, this information helps to relieve your anxiety.

Regards.
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Follow-up: Baby born with hydrocehpalus. Has fluid around the valve of the shunt. MRI and X-ray normal. Cause? 1 hour later
Uploaded Picture
 
 
Answered by Dr. Shivakumar S. Kupanur 3 days later
Hello.

Sorry for replying late.

Swelling appears significant. If it is tense and increasing in size, may require revision of shunt.

This can be decided only after clinical examination. If the child is symptomatically better and swelling is not increasing, you can wait and watch. If not, then I would suggest you to see your treating doctor.

I hope, this helps.

Regards.
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