Ventriculoperitoneal shunts in children: indications, equipment and techniques

The decision to implant a ventriculoperitoneal shunt in a child with ventriculomegaly should not be taken lightly. Once a shunt has been implanted, it is very difficult to determine that it is no longer necessary, and therefore the initial decision is very important. Sometimes the need is obvious, such as a baby who presents with irritability, vomiting, a full fontanelle, splayed sutures, and increasing head circumference. Similarly, older children with headaches, vomiting, and papilledema clearly require intervention. At the other end of the spectrum are children with moderately enlarged ventricles, normal development, and no progression in head size or ventricle size on imaging. Although the ventricles may be bigger than average in these children, a shunt should not be implanted unless their symptoms progress.