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<< Ventriculoperitoneal Shunt Complications In Children: An Evidence-Based Approach To Emergency Department Management

Pathophysiology

In patients with hydrocephalus, there is a disparity between CSF production and absorption. CSF is produced within the choroid plexus of the lateral, third, and fourth ventricles of the brain. It then flows through the ventricular system into the subarachnoid space via the foramen of Luschka and Magendie of the fourth ventricle and is absorbed by the venous system via the arachnoid villi and granulations. Any impairment to CSF circulation can lead to hydrocephalus, increased ICP, and dilation of the ventricular system. Some causes of hydrocephalus are acquired, such as intraventricular hemorrhage and brain tumors; others are congenital, such as stenosis of the aqueduct of Sylvius and myelomeningocele.1,5 Hydrocephalus most often occurs within the first year of life;16 the 3 most common causes are intraventricular hemorrhage (24%), myelomeningocele (21%), and brain tumors (9%).5

Shunt-related complications can be separated into 3 categories: mechanical failure, infection, and functional failure (See Table 1), although these categories can overlap. 

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