Hydrocephalus

Q: Are there specific precautions to having a VP shunt such as avoid rolling or hanging upside down or putting pressure on the location of the shunt?

A: This is a question that should really be discussed between a patient and their neurosurgeon. In general terms though, most neurosurgeons feel that non-contact physical activity is safe. A review of the literature found that less than 1% of all shunt problems were attributed to sport-related incidents. The Medical Advisory Board and the Board of Directors of the Hydrocephalus Association have issued a consensus statement encouraging participation in "regular activities including school and after school physical education programs and recreational sporting activities." This would include usual amounts of tumbling, rolling, and hanging upside down. This would also include non-sustained pressure over the shunt and tubing. For more information, review SBA’s health information sheet on hydrocephalus.

Q: Can you please demystify the rumor as to whether or not those with Spina Bifida and shunts have heightened hearing sensitivity to loud noises when compared to those without Spina Bifida?

A: This is a problem that others with hydrocephalus and shunts also complain about. We do not know exactly how common this is. While it does not affect everyone, it certainly bothers some of those with shunts. There are no studies of treatments for this problem of hyperacusis (oversensitivity to certain frequencies of noise) associated with shunts and hydrocephalus however, there are treatments recommended for the general population. There are audiologists and ENT physicians who specialize in this area and use a desensitization technique also used in tinnitus (a persistent ringing in the ear) called Tinnitus Retraining Therapy. In this therapy, patients listen to a broadband noise at soft levels for a defined period of time each day in order to increase their tolerances to sound. Aside from Tinnitus Retraining Therapy, you can use noise reduction head phones, ear muffs, and ear plugs to decrease the intensity of environmental noise, particularly when you will be in situations where loud noise is common.

Q: I am an adult with Spina Bifida who would like to have eye surgery to correct my near-sightedness. Is it safe for me? I have a VP shunt.

A: Corrective eye surgery is usually an outpatient procedure performed without general anesthesia. Since there is no general anesthesia and the surgery is limited to the cornea of the eye, this surgery is safe for someone with a ventriculoperitoneal (VP) shunt. It is important for everyone to visit an eye doctor on a regular basis. The Health Guide for Adults Living with Spina Bifida includes a section on making doctor's appointments that is helpful for adults concerned about their general health. This publication is available at SBA's Marketplace.

Q: Can I go scuba diving with a ventricular shunt?

A: Limited evidence suggests that someone with a ventricular shunt that does not drain into the blood stream can dive safely up to four atmospheres of pressure. This means that those who do not have a shunt that goes to the atrium (a ventriculoatrial or VA shunt) are most likely safe to dive down to 100 feet. This is based on research using decompression tanks (hyperbaric chambers) which showed that the shunts worked normally up to this pressure. The specialists believe that the shunt will drain normally because the brain/ventricles and the abdomen will be equally affected by the increased environmental pressure of the deeper water.
Special considerations include: results of neurologic exam, older shunts may not respond to pressure changes, shunts draining a syrinx have not been tested, shunts to the atrium are affected by blood stream, bowel and bladder surgeries and latex allergy as well as other issues. People with seizure disorders are not allowed to dive.

Q: My daughter has had symptoms of possible shunt malfunction: vomiting, visual difficulties, muscle numbness and weakness, and back pain. After having MRI and other tests, it seems that the shunt is working properly. In the absence of other evidence, the doctor thinks it may be migraines. Can you provide any insights to help me understand this issue better, including treatment for migraines?

A: There are migraines that can mimic shunt malfunction by causing the same symptoms:

  • Basilar-type migraine –Symptoms may include vertigo, double vision and vomiting.
  • Sporadic hemiplegic migraine – Symptoms include transient symptoms of hemiparesis and hemisensory changes.

In both of these, the symptoms usually, but not always, precede the occurrence of the headache. Treatment for immediate intense pain associated with migraines is generally ibuprofen, Tylenol or prescription sumatriptan nasal spray. Chronic (long- term) treatment usually involves behavioral strategies (biofeedback, relaxation therapy, etc) and medications – the best studied of these are topiratmate (Topomax), valporic acid, levetiracetam (Keppra) and amitryptyline.
Because shunt malfunction is not always clear-cut, "no improvement" or "worsening" requires re-evaluation by the neurosurgeon and possibly further evaluation of the shunt.  In such cases, the patient needs to be in frequent contact with the primary physician or pediatrician and neurosurgeon. For more information, review SBA’s health information sheet on chronic pain.