Ventriculoperitoneal (VP) shunt placement is surgery to relieve increased pressure inside the skull due to excess cerebrospinal fluid (CSF) in the brain (hydrocephalus), which can lead to brain damage. Hydrocephalus can occur for many reasons, including brain tumors, bleeding inside the brain, and meningitis. These conditions lead to hydrocephalus through disruption of the delicate balance between production and absorption of cerebrospinal fluid.
People of any age can develop hydrocephalus and therefore require a VP shunt. Excess fluid can build up around the brain for a number of reasons, including: -Overproduction of CSF -Poor absorption of CSF by the blood vessels -Blockages preventing fluid from flowing throughout the brain -Blockages are the most common cause of hydrocephalus. Cysts, tumors, or inflammation in the brain can impede the normal flow of CSF and create an unsafe accumulation. Imaging tests can confirm the diagnosis of hydrocephalus. Ultrasound, CT scans, and MRI scans allow doctors to view the cavities and tissues within the brain. Testing will show if areas of the brain contain more fluid than normal.
The procedure is used to relieve pressure on the brain caused by fluid accumulation.
Doctors typically perform the placement of a VP shunt while a patient is under general anesthesia. You’ll be asleep during the surgery and won’t experience pain. The entire procedure takes about 90 minutes. The surgical nurse will shave the area behind your ear in preparation for shunting, as this is where they will place the catheter. Catheters are thin, flexible tubes used to drain excess fluid. A surgeon will make a tiny incision behind the ear and will also drill a small hole in the skull. They will then thread one catheter into the brain through this opening. The other catheter goes behind your ear and is subcutaneous, meaning it resides under the skin. This tube travels down to your chest and abdomen, allowing excess CSF to drain into the abdominal cavity, where your body absorbs it. Your surgeon may attach a tiny pump to both catheters and place it under the skin behind your ear. The pump will automatically activate to remove fluid when the pressure in the skull increases. It may even be possible to program the pump, also called a valve, to activate when the fluid increases to a certain volume.
The doctor may order the following tests for you: -Physical exam and medical history -Blood tests You will also discuss with your doctor about your medications. You may be asked to stop taking some medications up to 2 weeks before the procedure. Before the procedure, you should: -Arrange for a ride home from the hospital. -Arrange for help at home, as you recover. -Eat a light meal the night before your surgery. Do not eat or drink anything after midnight unless told otherwise by your doctor. -Talk to your doctor if you take any medications, herbs, or supplements.
Recovery from a VP shunt placement takes three to four days. Most people can leave the hospital within seven days after the procedure. During your hospitalization, the hospital staff will monitor your heart rate and blood pressure, and your doctor will administer preventive antibiotics. Your doctor will make sure the shunt is working properly before you leave.
Placement of a shunt is a very safe procedure. However, complications can occur during or after the procedure. Risks associated with any surgical procedure include excessive bleeding and infection. You might also experience adverse reactions to anesthesia, such as breathing difficulties, changes in heart rate, or changes in blood pressure levels. There are rare risks specific to VP shunting that can be serious and potentially life-threatening if left untreated, including: -Infection in the shunt or brain -Blood clots -Bleeding in the brain -Damage to brain tissue -Swelling of the brain Fever, headache, abdominal pain, fatigue, and a spike in blood pressure levels, or having the same symptoms that were present when the shunt was initially placed, can indicate an infection or a malfunction of the shunt.
How Do VP Shunts Work?
Most shunts have two catheters (small, thin tubes) connected by a valve. One end of the upstream catheter is in a ventricle. The other end of the downstream catheter is in the peritoneal (pair-et-NEE-ul) cavity. This is the space inside the belly where the stomach and the bowels sit. The shunt is all inside the body, under the skin. The valve opens when the pressure in the brain gets too high. This lets fluid drain from the brain into the peritoneal space. From there, the extra fluid is absorbed into the bloodstream and filtered out in the kidneys. Then the body can pee out the extra fluid.
How effective is a VP shunt in treating my condition?
A VP shunt is an effective way to treat the symptoms of hydrocephalus. When fitted, a ventriculoperitoneal shunt successfully drains CSF and reduces brain pressure for most people. Sometimes a ventriculoperitoneal shunt will stop working and need replacing. A person’s outlook will depend on the underlying cause of their hydrocephalus. They may require other treatment to manage their condition. Early diagnosis and treatment for hydrocephalus may improve a person’s outlook.