Ventriculoperitoneal shunting

  • Definition
    • Ventriculoperitoneal shunting is surgery to treat excess cerebrospinal fluid (CSF) in the brain (hydrocephalus).

  • Alternative Names
    • Shunt - ventriculoperitoneal; VP shunt; Shunt revision

  • Description
    • This procedure is done in the operating room under general anesthesia. It takes about 1 1/2 hours.

      The procedure is done as follows:

      • An area of hair on the head is shaved. This may be behind the ear or on the top or back of the head.
      • The surgeon makes a U-shape cut behind the ear. Another small surgical cut is made in the belly.
      • A small hole is drilled in the skull. A thin tube called a catheter is passed into a ventricle of the brain. This can be done with or without a computer as a guide. It can also be done with an endoscope that allows the surgeon to see inside the ventricle.
      • Another catheter is placed under the skin behind the ear. It is sent down the neck and chest, and usually into the belly area. Sometimes, it stops at the chest area. The doctor may make a small cut in the neck to help position it.
      • A valve (fluid pump) is placed underneath the skin behind the ear. The valve is connected to both catheters. When extra pressure builds up around the brain, the valve opens, and excess fluid drains through the catheter into the belly or chest area. This helps lower intracranial pressure.
      • The person is taken to a recovery area and then moved to a hospital room.
  • Why the Procedure Is Performed
    • This surgery is done when there is too much cerebrospinal fluid (CSF) in the brain and spinal cord. This is called hydrocephalus. It causes higher than normal pressure on the brain. It can cause brain damage.

      Children may be born with hydrocephalus. It can occur with other birth defects of the spinal column or brain. Hydrocephalus can also occur in older adults.

      Shunt surgery should be done as soon as hydrocephalus is diagnosed.

  • Risks
    • Risks of anesthesia and surgery in general are:

      • Reactions to medicines or breathing problems
      • Bleeding, blood clots, or infection

      Risks of ventriculoperitoneal shunt placement are:

      • Blood clot or bleeding in the brain
      • Brain swelling
      • Hole in the intestines (bowel perforation), which can occur later after surgery
      • Leakage of CSF fluid under the skin
      • Infection of the shunt, brain, or in the abdomen
      • Damage to brain tissue
      • Seizures

      The shunt may stop working. If this happens, fluid will begin to build up in the brain again. As a child grows, the shunt may need to be repositioned.

  • Before the Procedure
    • If the procedure is not an emergency (it is planned surgery):

      • Tell the health care provider what medicines, supplements, vitamins, or herbs the person takes.
      • Take any medicine the provider said to take with a small sip of water.

      Ask the provider about limiting eating and drinking before the surgery.

      Follow any other instructions about preparing at home. This may include bathing with a special soap.

  • After the Procedure
    • The person may need to lie flat for 24 hours the first time a shunt is placed.

      How long the hospital stay is depends on the reason the shunt is needed. The health care team will closely monitor the person. IV fluids, antibiotics, and pain medicines will be given if needed.

      Follow the provider's instructions about how to take care of the shunt at home. This may include taking medicine to prevent infection of the shunt.

  • Outlook (Prognosis)
    • Shunt placement is usually successful in reducing pressure in the brain. But if hydrocephalus is related to other conditions, such as spina bifida, brain tumor, meningitis, encephalitis, or hemorrhage, these conditions could affect the prognosis. How severe hydrocephalus is before surgery also affects the outcome.

  • References
    • Hdeib A, Cohen AR. Hydrocephalus in children and adults. In: Ellenbogen RG, Abdulrauf SI, Sekhar LN, eds. Principles of Neurological Surgery. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 6.

      Meltzer H. Insertion of ventriculoperitoneal shunt. In: Jandial R, McCormick PC, Black PM, eds. Core Techniques in Operative Neurosurgery. Philadelphia, PA: Elsevier Saunders; 2011:chap 52.