Shunts

I would like to receive any input I can get on the possibility of putting in a shunt for my husband. He was in a coma, but now seems to be in more of a minimally conscious state. He can respond to "move your thumb" or "close your eyes", but not consistently. He has extended periods with his eyes open, and can definitely focus, though he cannot follow the dr's finger. The doctor didn't say much at his follow up (the first since having the surgery to remove his AVM on October 30th), other than he can offer me the option to place a shunt and that that may or may not help us see more improvement. I'd like to hear some pros and cons, was anyone here in a coma for an extended time? We are almost on 3 months now. I haven't given an answer yet.

Was in a coma for only weeks, not months. Had a shunt put in a few days after my bone flap replacement. Original shunt replaced a week later with an adjustable one
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Hi Mary,

I had an old friend who had a shunt put in for an inoperable brain tumor. It was put in to release the pressure in the area and to allow the fluid to drain. The first surgery, her body rejected it and they had put a new one in. Other than that, she had no complications at all and it helped her immensely. Before the surgery, she was sleeping up to 18 hours a day and had trouble comprehending simple things. The dr. said it was from the pressure of the fluids building up in her brain that was causing it. It was about three days after they put the shunt in that she was almost back to her normal self. It was long time ago but, I think it was about 2 weeks and she was her normal self again. I can honestly say this because, she was my girlfriend at the time (back in 1987?) and we lived together. It was rough road for quite a while till they did the surgery.

The dr. must think there's a chance this could help him. Or else he wouldn't have suggested it. That's my take on it, anyway.

I'm sure others with more information will be answering you soon.

Ben

Thank you so much for your input. Sounds encouraging.

How is an adjustable one different? What caused them to change it?

One question just came to my mind. Do you recall how they know it was being rejected?

And thank you for responding to my question:).

I don't know anything about 'adjustable" ones. I never heard of those before. I would like to know how they work too.
They had to change it because they said her body was rejecting it. If I remember it right, the second shunt surgery was a month after the first one. I'm not sure how they knew it was being rejected but, I do remember them keeping a close eye on her after the surgery and she had to have tests done quite regularly. I think it was MRIs, Cat Scans and some blood work. I'm really jaring my memory on this. After all, this was back in the mid 80's. Now that I think about this. With her surgery being done back in the 80's and it being very successful. Think of what they can do now in comparison to back then.

I believe what they refer to as "being rejected" is, the body treats it like it was an infection/an outsider and the antibodies attack it. Like it would any kind of an infection.

Another thing that could(?) cause them to change it is if it would become blocked. She didn't have that problem but, I do remember them saying that is one of the things they monitor for.

They monitored her for a awhile and ran tests on a regular basis to make sure everything was ok. As I said up above. I think those tests were MRIs, cat scans, and blood work. I don't remember if they did any spinal taps (lumbar puncture) or not. They could have. I do remember they were pretty quick in detecting it though.

thank you once again....very much

Hi Mary - I had a bleed/emergency brain surgery, and they told my then-boyfriend that my brain was swelling so they had to put a shunt in to relieve the swelling. I was then in a 3-week coma.

At the time of the need for a shunt, I was unconscious, and there was really no choice to make. They had to decrease the swelling so my brain stayed contained within my skull.

You might consider asking the doctor more questions of how the shunt will benefit your husband. Also, have you considered getting a second and/or third opinion?

Hi Mary, I have had a VP shunt since November 2009. I just recently, unexpectedly, had a shunt revision 4 years after my initial implant. The shunt is a life-saver and I have posted blogs about my experience with it several times. I wish you and your husband the best. What I have been told by my neurosurgeons and others is some shunts go weeks with no problems and others go 20+ years with never having any problems? In my opinion, the best thing to know is symptoms to lookout for with a possible shunt malfunction and not to take hydrocephalus lightly. I have been extremely lucky with my two episodes of hydrocephalus and now remain very aware of any unusual symptoms. Hope this is helpful, best wishes for your husband. GK

Thank you. They made it sound like it was optional and for me to decide. Yes, good idea to get another opinion.

Hi Mary, shunts are not "rejected" by our bodies. Organ transplants get rejected, but implants like a VP shunt can become infected or malfunction. At that point a replacement or revision shunt must be implanted. Shunts have been around a long time, this is not new technology. The programmable shunts are somewhat newer and use an electromagnetic remote control to monitor and control the pressure in the valve portion of the shunt. These shunts may be easier to monitor and adjust should an increase in pressure arise. I am on my second gravitational(non-programmable) shunt and doing well. Best of luck, keep us posted. GK

Thank you for the clarification, and for sharing your experience. It was helpful.

Hi Mary,

First off, I'm not a doctor but my daughter has two shunts in place as the result of hemorrhages. They're in place because she had a lot of swelling post bleeds and they were necessary to help regulate intracranial pressure. She spent weeks with external ventricular drains before it was determined that a more permanent solution was needed. She has both a front drain and a 4th ventricular drain. The front drain had to be revised a month or two after placement due to a clog.

I'm assuming that your husband currently has an external ventricular drain in? If not, I'm not sure I understand the option of placing a shunt.

My husband has no drain. He did following his first surgery, which was to remove the large blood clot, and after the third, which was to remove the AVM...both were removed. We were told there was still swelling when we left the hospital for sub acute...and the dr. said it would take at least 6 weeks to go down. Upon return 6 weeks later, the dr. said it was improved and there was still an "area of drainage". He basically said we could try a shunt, but he could not promise it would or would not work, or how much. Seemed just something I could decide to try, not something he was saying was urgently needed. I want to wait another 6 weeks and see if there is further progress...but worry that potentially waiting could take away some of the progress or healing that could take place. I hope that makes sense.

I have had a shunt for two years. It appears to be okay.

Thank you so much.