Alternative names: Shunt – ventriculoperitoneal; VP shunt; Shunt revision
Definition: Ventriculoperitoneal shunting is surgery to treat excess cerebrospinal fluid (CSF) in the cavities (ventricles) of the brain (hydrocephalus).
This procedure is done in the operating room under general anesthesia. It takes about one and a half hours. A tube (catheter) is passed from the cavities of the head to the abdomen to get rid of the excess cerebrospinal fluid (CSF). A pressure valve and an anti-syphon device ensure that just the right amount of fluid is drained.
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 skin incision behind the ear. Another small surgical cut is made in the belly.
- A small hole is drilled in the skull. One end of the 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.
- A second 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. In the belly, the catheter is often placed using an endoscope. The doctor may also make a few more small cuts, for instance in the neck or near the collarbone, to help pass the catheter under the skin.
- A valve is placed underneath the skin, usually 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. A reservoir on the valve allows for priming (pumping) of the valve and for collecting the CSF if needed.
- 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. Alternative surgeries may be proposed. Your doctor can tell you more about these options.
Risks for anesthesia and surgery in general are:
- Reactions to medicines or breathing problems
- Bleeding, blood clots or infection
Risks for 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
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.
The length of the hospital stay 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.
Shunt placement is usually successful in reducing pressure in the brain. But if hydrocephalus is related to other conditions, such as spina bifida, brain tumour, meningitis, encephalitis or hemorrhage, these conditions could affect the prognosis. How severe hydrocephalus is before surgery also affects the outcome.
Badhiwala JH, Kulkarni AV. Ventricular shunting procedures. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 201.
Rosenberg GA. Brain edema and disorders of cerebrospinal fluid circulation. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley’s Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 88.