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Baby Was Born With Congenital Hydrocephalus. Has Fluid Around The Valve Of The Shunt. MRI And X-ray Normal

Posted on Sat, 27 Jul 2013

Question: my baby was born with congenital hydrocephalus. she has a vp shunt. she has fluid around the valve of the shunt. i was by the ns today and took a mri and xray of babys brain. doctor said everything looks good. so why would there be fluid around the shunt valve if everything looks ok in the mri and exray. is the shunt working properly?

Answered by Dr. Sudhir Kumar (1 hour later)

Hi,
Thank you for posting your query.
It is not unusual for accumulation of a small amount of fluid around the shunt valve.
The fact that your baby is well, and the repeat MRI did not show hydrocephalus, indicate that the shunt is working properly.
There are two major problems to look for in a VP shunt- shunt infection (when there would be fever and headache) and shunt block (when there would be headache, vomiting and hydrocephalus on MRI or CT).
At present, there is no need to worry.
Please get back if you require any additional information.

Best wishes,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (1 hour later)

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.

Answered by Dr. Sudhir Kumar (7 hours later)

Thank you for getting back.
Daily, the fluid in the brain is changed four times, so, there is a lot of fluid production in any case. Fluid accumulation can happen normally without any disease also.
By pressing, a doctor can check whether the shunt is working or not.
If the shunt is not working or working slowly, we can see hydrocephalus on the brain scan, so, I think it is working well in your child's case.
Valves prevent any reverse flow of the fluid.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (11 hours later)

how does the fluid buildup happen? is it coming out of the shunt under the skin? is it coming out of the hole in the skull thats made when the shunt is placed?
Thanks for your answers

Answered by Dr. Sudhir Kumar (3 hours later)

Thank you for getting back.
Fluid build up can happen because of local fluid secretion at the site of build up, as well as through the hole in the skull. Small amounts can also come under the skin near the shunt tube.
I appreciate your insightful questions.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sudhir Kumar (12 hours later)

thanks for your detailed answers. whats local fluid secretian. fluid gets produced also at the sight where the valve is? not only in the brain?
Thanks!

Answered by Dr. Sudhir Kumar (1 hour later)

Thank you for getting back.

Cerebrospinal fluid (CSF) secretion occurs only in brain and spinal cord. However, there are fluids elsewhere in the body too. So, I referred to other fluids, and not the CSF.

Best wishes,
Dr Sudhir Kumar MD DM

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Sudhir Kumar (6 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. Sudhir Kumar (3 hours later)

The hole in the skull should not be a problem. As even if it was big, the bone around the shunt tube would grow to fit the tube.

Best wishes,
Dr Sudhir Kumar MD DM

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sudhir Kumar (2 hours later)

Uploaded Picture

Answered by Dr. Sudhir Kumar (7 hours later)

Thank you for getting back.

Sending the picture does help. I also showed the picture and discussed with my neurosurgery colleague. He is of the opinion that the fluid collected in your child's case is CSF (cerebrospinal fluid). This can be either due to bigger hole in the skull or non-functioning of shunt. Therefore, the best option is to revise (remove the current shunt, and put another new shunt) the shunt, as this is a non-programmable shunt.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (8 hours later)

so why does the doctor tell me that it can be fluid collection even if the shunt is working properly. he said the mri showed that its working. so does the shunt need to be replaced even if the mri shows that its working. should I change doctors?
when do you put a programmable shunt and when do you put a non programmable shunt?
he said that a programmable shunt needs to be reprogrammed everytime the baby has an mri. so thats why he put a non programmable shunt.

Answered by Dr. Sudhir Kumar (5 hours later)

Thank you for getting back.
You should take an opinion from another neurosurgeon.
It is possible that the shunt is working, in that case, the fluid collection could be because of bigger hole in the skull bone. Even if the shunt is working, it needs to be replaced, as the fluid is accumulating in the scalp, which may increase further. Moreover, there is a risk of infection too.
Programmable shunts are put, when we want the option of being able to change parameters later on. Regarding MRI, your doctor is correct. Non programmable shunts have lesser hassles, and there is no problem with MRI with non programmable shunts.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Shanthi.E