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 patient 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 are:

  • Reactions to medications
  • Problems breathing
  • Changes in blood pressure or breathing rate

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 your doctor or nurse what medicines, supplements, vitamins, or herbs the patient takes.
  • Take any medicine the doctor said to take with a small sip of water.
  • Be sure to arrive on time at the hospital.

Ask your doctor or nurse about eating and drinking before the surgery. The general guidelines are:

  • Older children and adults should not eat any food or drink any milk for 6 hours before surgery. But they can have clear fluids (juice or water) up until 4 hours before the operation.
  • Infants younger than 12 months can usually eat formula, cereal, or baby food until about 6 hours before surgery. They may have clear fluids up until 4 hours before the operation.

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

After the Procedure

Children need to lie flat for 24 hours the first time a shunt placed. After that, your child will be helped to sit up.

Children and adults stay in the hospital for 2 to 4 days. The health care team will closely monitor the patient. IV fluids, antibiotics, and pain medicines will be given if needed.

Follow your health care 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.

Figures

Ventricles of the brainCraniotomy for cerebral shuntVentriculoperitoneal shunt - series

References

Kinsman SL, Johnston MV. Congential anomalies of the central nervous system. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 585.11.

Rosenberg GA. Brain edema and disorders of cerebrospinal fluid circulation. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 59.

Revision

Last reviewed 10/29/2013 by Joseph V. Campellone, M.D., Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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