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Life with a cerebrospinal fluid (CSF) shunt

BMJ 2016; 355 doi: http://dx.doi.org/10.1136/bmj.i5209 (Published 26 October 2016) Cite this as: BMJ 2016;355:i5209
  1. Dmitri Shastin, neurosurgical registrar1,
  2. Malik Zaben, clinical lecturer in neurosurgery1 2,
  3. Paul Leach, consultant neurosurgeon1
  1. 1Department of Neurosurgery, University Hospital of Wales, Cardiff CF14 4XW, UK
  2. 2Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Institute of Psychological Medicine and Clinical Neurosciences, University Hospital of Wales, Cardiff CF14 4XN
  1. Correspondence to: D Shastin dmitri.shastin{at}gmail.com

What you need to know

  • Having a cerebrospinal fluid (CSF) shunt places few limitations on life

  • Once stable after the procedure, the shunt should place no or few restrictions on driving, travel, sexual intercourse, sports, and pregnancy

  • Support for patients and networking opportunities are available from charity organisations such as SHINE, SBH Scotland, and Headway

Cerebrospinal fluid (CSF) shunts divert CSF from the brain, usually to the abdominal cavity. They can be used for a variety of conditions including hydrocephalus, idiopathic intracranial hypertension, syrinx, and pseudomeningocoele. Cerebrospinal fluid can be drained directly from the ventricles of the brain with a ventriculoperitoneal shunt (fig 1) or, less commonly, from the spinal subarachnoid space with a lumbo-peritoneal shunt. It is estimated that between 3000 and 3500 shunt operations are performed in the United Kingdom every year,1 affecting a wide range of patients with both congenital and acquired conditions.

Fig 1 Diagram of ventriculoperitoneal shunt

Patients will have different concerns about their shunt. Managing this population may seem challenging for the non-expert, but advice on specific lifestyle alterations can come from non-specialists.

Common areas of concern

Driving

UK guidance states that patients must not drive for six months after an operation involving the ventricular end of the shunt.2 No driving restrictions apply if only the peritoneal part of the shunt is revised, although any associated conditions such as epilepsy should be regarded separately. Often patients will know when they have high pressure headaches (commonly described as being constant and made worse on lying down or bending),3 and in such cases driving should be avoided until shunt malfunction is ruled out or the symptoms resolve.

Travel

There is no evidence that flying is detrimental or dangerous,4 but some patients may be concerned about being …

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