Complications / Side Effects; Obstruction; Infection; Overdrainage - Sophysa Sophy Notice D'emploi

The doctor is responsible for informing the patient or
his/her family that the person fitted with a shunt must avoid
any activity that may subject this shunt to direct shocks
(violent sports, etc.) as these are likely to damage it.
WARNING
The pressure settings must be checked routinely before and
after exposure to a powerful magnetic field or if there is an
impact at the implantation site.
PRECAUTION
The patient must be warned that vibrations due to the CSF
flow may possibly be felt because of the implantation of the
valve on the skull.

11. Complications / Side effects

Complications which may result from the implantation of
a CSF shunt system include the inherent risks in the use
of drugs, any surgical intervention and the insertion of a
foreign body.
PRECAUTION
Patients treated with a shunt system must be closely
monitored post-operatively in order to detect any signs of
complications early.
The doctor is responsible for educating the patient or
his/her family about CSF shunt systems, in particular
describing the complications linked to implanted shunt
systems as well as giving explanations about possible
alternative therapies.
The main complications of shunts are obstruction, infection
and over-drainage. These complications require the rapid
intervention of a doctor.

11.1. OBSTRUCTION

Obstruction is the most frequent complication in shunt
systems. It can occur at any point in a shunt.
The ventricular catheter can be obstructed by a blood clot,
cerebral tissue or even tumoral cells.
The end of the ventricular catheter can also become
embedded in the choroid plexus or in the ventricular wall,
either directly or following a collapse of the walls, a
consequence of over-drainage.
The cardiac catheter can be colonized by a thrombus while
the appearance of a clot around the catheter could cause
an embolism in the pulmonary circulation.
The peritoneal catheter may become obstructed by the
peritoneum or by intestinal loops.
Loss of patency in a shunt may also be the result of an
obstruction by fragments of cerebral tissue or by biological
deposits (protein deposits, etc.).
Obstruction of the shunt will quickly result in the
reappearance of the signs and symptoms of intracranial
hypertension.
These signs and symptoms vary from patient to patient and
over time.
In infants and young children, the symptoms may be an
abnormal increase in the size of the skull, a bulge in the
fontanelles, dilation of the scalp veins, vomiting, irritability
with a lack of attention, downward deviation of the eyes,
and sometimes convulsions.
In older children and adults, intracranial hypertension due
to hydrocephalus may be the cause of headaches,
vomiting, blurred vision, diplopia, drowsiness, slowing of
movements, gait disorders or psychomotor slowing which
could lead to total invalidity.
If an obstruction is confirmed and a patency test does
not make it possible to reduce the obstruction, revision
surgery or removal of the device must be envisaged.

11.2. INFECTION

Chronic malfunction of the shunt could cause a leak and
a discharge of CSF along its length increasing the risk of
infection.
Local or systemic infection
complication of CSF shunt systems. It is generally
secondary to the colonization of the shunt by cutaneous
germs. Nevertheless, as for all foreign bodies, any local
or systemic infection can colonize the shunt. Erythema,
edema and skin erosions along the length of the shunt may
be an indication of an infection of the shunt system.
Prolonged, unexplained fever may also be the result of a
shunt system infection.
Septicemia, favored by an alteration in general status, can
start from a shunt infection.
If there is infection, removal of the system is indicated
in conjunction with the start of a specific treatment by
a general or intrathecal route.

11.3. OVERDRAINAGE

Overdrainage can result in a collapse of the ventricles
(slit ventricle syndrome) and the appearance of a
subdural hematoma.
In children, depression of the fontanelles, overlapping of
the scalp bones, even a craniostenosis or a change from
communicating hydrocephalus
hydrocephalus by stenosis of the Aqueduct of Sylvius
could occur.
Adults can present with a variety of symptoms such as
vomiting, auditory or visual disorders, drowsiness or even
headaches in the upright position but which improve in the
supine position.
Depending on clinical observations and medical
imaging, the doctor can reduce the symptoms of over-
drainage and correct the ventricle size by changing the
operating pressure of the Sophy
However, immediate drainage of a subdural hematoma
may be indicated.
11.4. COMPLICATIONS SPECIFIC TO
LUMBOPERITONEAL SHUNTS
The lumbar catheter may migrate in the sub-arachnoid
space. The peritoneal catheter may migrate in the
peritoneal cavity under the action of intestinal peristaltic
waves. Perforation or occlusion of abdominal viscera by
the peritoneal catheter could occur.
Growth of the body may progressively cause the catheters
is another possible
to obstructive
®
valve.
ENGLISH – 17