Shunt Surgery for Medulloblastoma: What Preparations Do Patients and Families Need to Make? When Can the Abdominal Shunt Tube Be Removed?

Shunt Surgery for Medulloblastoma: What Preparations Do Patients and Families Need to Make? When Can the Abdominal Shunt Tube Be Removed?

Source: Sunflower Children  

Author: Sunflower Children  

Editor: Wuxiu  

Date: November 7, 2023  

The Q&A column on medulloblastoma will invite experts in the field of pediatric brain tumors to address various questions regarding medulloblastoma. Today, we present the 8th issue, and we welcome you to leave your questions in the comments section!

1. What preparations do patients and families need to make for shunt surgery?  

Firstly, family members should help the patient with skin cleanliness and protection of the head, neck, chest, and abdomen to avoid infections and injuries to the skin and soft tissues. Secondly, both the child and family should prepare psychologically, as some patients may experience complications such as shunt obstruction or infection post-surgery, which could require further surgery. It is also essential to prevent respiratory and digestive infections and fevers that could affect the surgery. Currently, there is a significant price difference for shunt tubes used in surgeries due to varying pressure regulation and anti-siphon functions; families should familiarize themselves with this information.

2. Why might there be abdominal pain after ventricular-peritoneal shunt surgery for medulloblastoma?  

In children, common causes of abdominal pain are intestinal cramps. After the shunt surgery, the presence of the shunt tube and cerebrospinal fluid in the abdominal cavity may disrupt the intestines. It could also be caused by gastroenteritis or other infections within the abdominal cavity. Additionally, abdominal pain may arise if the shunt tube is wrapped or adhered to the omentum or intestinal loops. Although rare, abdominal pain may also occur due to metastatic spread of the tumor to the abdominal cavity.

3. Does the abdominal shunt tube need regular pressure measurement and adjustment?  

First, it is essential to determine the type of shunt tube installed. If it is a non-magnetic shunt tube and the child is not experiencing symptoms of elevated intracranial pressure, such as headaches, nausea, vomiting, or blurred vision, regular pressure measurement and adjustment are usually unnecessary. If a standard adjustable shunt tube is installed, pressure adjustments must be made after exposure to strong magnetic fields (especially during MRI examinations). When symptoms of elevated intracranial pressure appear, pressure measurement and adjustment are also required. Furthermore, as infants grow, their physiological intracranial pressure changes, necessitating pressure adjustments based on symptoms and ventricular conditions.

4. Does medulloblastoma shunt surgery increase the risk of abdominal metastasis?  

Generally, medulloblastoma mainly spreads through cerebrospinal fluid circulation within the central nervous system. Metastasis to the brain and spinal cord is more common, and abdominal metastasis through the shunt tube is extremely rare.

5. Under what circumstances can the abdominal shunt tube be removed?  

In most cases, the shunt tube cannot be removed. Typically, if the valve of the shunt tube is slow to rebound or does not rebound at all, it indicates that the shunt is obstructed or completely blocked. If the child does not present symptoms of elevated intracranial pressure, the tube can be removed. However, before removal, the abdominal end of the shunt tube must be ligated, and the child must be observed for any symptoms of elevated intracranial pressure. If there are no symptoms and follow-up imaging shows no ventricular enlargement, the tube can be removed. Additionally, if the ventricular system has satisfactorily recovered post-shunt and the underlying condition has been resolved, the pressure can be gradually increased until it reaches the maximum. If the child can tolerate this without any discomfort, the ligation of the abdominal end of the shunt tube can be attempted, and if there are no symptoms, the tube can be removed. However, there is still a chance that the individual may not tolerate the removal and may require reinstallation of the shunt tube.

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