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Ventriculoperitoneal shunting

 

Definition

Ventriculoperitoneal shunting is surgery to relieve increased pressure inside the skull due to excess cerebrospinal fluid (CSF) on the brain (hydrocephalus).

This article primarily discusses shunt placement in children.

See also: Intracranial pressure

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 child's hair behind the ear is shaved off. A surgical cut in the shape of a horseshoe (U-shape) is made behind the ear. Another small surgical cut is made in the child's belly.

A small hole is drilled in the skull. A small thin tube called a catheter is passed into a ventricle of the brain.

Another catheter is placed under the skin behind the ear and moved down the neck and chest, and usually into the abdominal (peritoneal) cavity. Sometimes, it goes to the chest area. The doctor may make a small cut in the neck to help position the catheter.

A valve (fluid pump) is placed underneath the skin behind the ear. The valve is attached to both catheters. When extra pressure builds up around the brain, the valve opens, and excess fluid drains out of it into the belly or chest area. This helps decrease intracranial pressure.

The valves in newer shunts can be programmed to drain more or less fluid from the brain.

Why the Procedure Is Performed

In hydrocephalus, there is a buildup of fluid of the brain and spinal cord (cerebrospinal fluid or CSF). This buildup of fluid causes higher-than-normal pressure on the brain. Too much pressure, or pressure that is present too long, will damage the brain tissue.

A shunt helps to drain the excess fluid and relieve the pressure in the brain. A shunt should be placed as soon as hydrocephalus is diagnosed.

Risks

Risks for any anesthesia are:

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

Risks for any surgery are:

  • Bleeding
  • Infection

Possible risks of ventriculoperitoneal shunt placement are:

  • Blood clot or bleeding in the brain
  • Brain swelling
  • The shunt may stop working and fluid will begin to build up in the brain again
  • The shunt may become infected
  • Infection in the brain
  • Damage to brain tissue
  • Seizures
Before the Procedure

If the procedure is not an emergency (planned surgery):

  • Tell your doctor or nurse what drugs, supplements, vitamins, or herbs your child takes.
  • Give any drugs the doctor told you to give your child. It is okay if they take them with a small sip of water.
  • The doctor or nurse will tell you when to arrive at the hospital.

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

  • Older children 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 fewer 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.

Your doctor may ask you to wash your child with a special soap on the morning of the surgery. Rinse well after using this soap.

After the Procedure

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

The usual stay in the hospital is 3 to 4 days.The doctor will check vital signs and neurological status often. Your child may get medication for pain. Intravenous fluids and antibiotics are given. The shunt will be checked to make sure it is working properly.

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. The severity of hydrocephalus present before surgery will also affect the outcome.

Support groups for families of children with hydrocephalus or spina bifida are available in most areas.

The major complications to watch for are an infected shunt and a blocked shunt.

References

Etilogical categories of neurological disease. In: Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 28.

Kinsman SL, Johnston MV. Congential anomalies of the central nervous system. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 592.


Images
Ventricles of the brain Craniotomy for cerebral shunt Ventriculoperitoneal shunt - series
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Review Date: 12/21/2009
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. Previously reviewed by Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. 1/12/09
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