Over time the practitioner will be asked certain questions by nearly every patient with hydrocephalus. Many of these questions are listed below.
- Will my shunt be affected by a MRI scan? All valves are MRI-compatible; however, some have an adjustment device that contains a magnet, and the setting can be modified by the high magnetic field inside the MRI. This can cause overdrainage or underdrainage and may require verification and resetting of the valve after the MRI. However, this readjustment will not result in shunt obstruction or increases in pressure within the head that threaten acute injury. Older valves predating the introduction of MRI technology may contain metallic parts that can cause artifact on the images.
- What are the occupational hazards for a person with a shunt? Occupational risks in hydrocephalic patients are mostly the results of their underlying disease and not the shunt. Limitations can result from motor deficit, mental delay, visual impairment, imbalance, or epilepsy. Neurologically intact patients should be allowed to practice all jobs. Very high magnetic fields have been found to change the setting of some adjustable valves (40), but such exposures in the industry are exceptional (one case in the author’s experience, unpublished data), and patients with magnet-adjustable valves as well as other valves should not be discriminated against. In general, all efforts should be made to integrate patients with hydrocephalus into active life and resist discrimination.
- Can I travel by air? Unlike gases, liquids do not expand or contract significantly with variations in atmospheric pressure. Therefore, one should not anticipate changes in altitude causing changes in ICP or flow of fluid through the shunt. No limitations should apply to those with shunts. However, traveling far away requires planning (in particular, having the necessary medical documents ready and taking insurance for repatriation) in case a problem occurs during travel.
- Which sports can I participate in? Reservations are sometimes expressed about participating in contact and combat sports. However, no shunt complication related to normal sports practice has been reported, and most neurosurgeons do not restrict sports activity in patients with shunts (5). In our experience, only one patient had a sports-related complication among more than 2000 patients followed for an average 10 years (one event for some 20,000 patient-years follow-up); in this case a pétanque ball hit the patient’s valve and damaged it. Overall, the additional risks associated with sports should be considered negligible. By contrast, the benefits of participating in sports are many, chief among them promoting social interaction, avoidance of discrimination, and the encouragement of physical fitness. Some reservations might apply to scuba diving, because of the theoretical risk of epilepsy caused by a higher partial pressure in oxygen and a predisposition to epilepsy in patients with shunts (snorkeling is safe). This concern is hypothetical, however, and motivated patients should be allowed to dive, provided a strict respect of standard safety guidelines are followed, such as avoiding diving alone and in deep waters (2).
- Do I need to undergo systematic shunt revision? The fact that reoperations are frequent does not mean that they are inevitable. Normally, even in neonates, the length of the peritoneal catheter should suffice for growth to adult stature, and catheter lengthening is not warranted. Decisions for reoperation are based on the clinical status of the patient (shunt malfunction or intolerance of a chronic shunt failure) (44).