The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on lumbar subcutaneous shunt.
As part of the NICE's work programme, the current guidance was considered for review but did not meet the review criteria as set out in the IP process guide. The guidance below therefore remains current.
This procedure is used to treat communicating hydrocephalus (also known as normal pressure hydrocephalus) and benign intracranial hypertension (or pseudotumour cerebri).
Communicating hydrocephalus is an uncommon condition caused by excess fluid (cerebrospinal fluid) collecting in the space in the subarachnoid space. It may be due to a congenital abnormality, a brain haemorrhage or meningitis. Sometimes no cause is identified. The symptoms are confusion, gait disturbance and incontinence of urine. The condition may cause brain damage or death if not treated.
Benign intracranial hypertension is an uncommon condition of unknown cause, in which the pressure of cerebrospinal fluid is increased. The symptoms include headache, dizziness and visual problems. The prognosis is generally good, although a few people may experience permanent visual loss.
A cerebrospinal fluid shunt is a system of valved tubes which diverts cerebrospinal fluid from the subarachnoid space into another part of the body to drain it and prevent damage to the brain or eyes.
Usually, a shunt is tunnelled under the skin, with the upper end in a cerebral ventricle and the lower end is in the heart (ventriculo-atrial shunt) or in the peritoneum (ventriculo-peritoneal shunt). Alternatively, the upper end of the shunt is placed in subarachnoid space in the lumbar part of the back and the lower end drains fluid into the peritoneum (lumboperitoneal shunt).
A lumbar subcutaneous shunt differs from these types of shunt in that the cerebrospinal fluid drains into the potential space immediately under the skin. A narrow tube is inserted into the subarachnoid space in the lumbar part of the back during a lumbar puncture. It is then fed under the skin to a site where it can drain fluid, usually in the flank or abdomen.The advantage is that, unlike other shunt procedures, general anaesthetic is not required.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.