Obstruction; Infection; Overdrainage; Other - Sophysa POLARIS SPV-SX Notice D'emploi

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.
is another possible

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 overdrainage and
correct the ventricle size by changing the operating
®
pressure of the Polaris valve.
However, immediate drainage of a subdural hematoma
may be indicated.

11.4. OTHER

Failure of a shunt system may also be linked to
disconnection of its various components.
The ventricular catheter may migrate inside the ventricle.
The peritoneal catheter may migrate into the peritoneal
cavity under the action of the peristaltic waves of the
intestine, while an atrial catheter may migrate into the right-
hand cavities of the heart following the blood flow.
Perforation or occlusion of abdominal viscera by the
peritoneal catheter could occur.
Growth of the body may progressively cause the catheters
to exit their insertion sites.
These malfunctions
repositioned immediately.
Cases of cutaneous necrosis over the implantation site are
possible.
Over time fibrous adhesions may fix the ventricular
catheter in the choroid plexus or the cerebral tissue. If
removal is being considered, gentle rotation of the catheter
about its axis may make it possible to free it. The catheter
should never be withdrawn forcibly. If it cannot be taken
out without forcing, it is preferable to leave it in place rather
than risk an intra-ventricular hemorrhage.
Cases of allergy to silicone have been described.
Cases of epilepsy after implantation of a ventricular shunt
have been described.
The ruby ball in the valve can potentially take up an off-
center position on its housing due to the presence of a
cluster of cells or protein deposits. Among others, such
situations can cause :
— loss of regulatory function in the valve potentially
increasing the risk of overdrainage.
— an impaired anti-reflux function.
The mobility of the rotor could be impeded by an
aggregation of cells or a protein deposit. This could make
it impossible to adjust the valve with the Magnet.
to obstructive
require the shunt
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to be