What is a Ventriculoperitoneal Shunt?
A ventriculoperitoneal (VP) shunt is a medical device used primarily to treat an abnormal brain condition called hydrocephalus.
Hydrocephalus is a condition characterised by excessive accumulation of cerebrospinal fluid (CSF) in and around the brain that causes swelling and affects normal brain function. CSF is the fluid that surrounds the brain and the spinal cord. It is produced by hollow spaces inside the brain called ventricles. The fluid protects your brain and spinal cord from injury by functioning as a cushion. Usually, CSF drains out of the brain through the ventricles and into the spinal column and is then absorbed by the body. However, if the circulatory path of the CSF becomes obstructed and the fluid cannot drain out properly, the fluid accumulates, causing the ventricles to swell and the pressure inside the head to increase.
A ventriculoperitoneal shunt relieves pressure by draining excess CSF from the brain to restore its normal flow and absorption within the brain.
What is Ventriculoperitoneal Shunt Placement?
Ventriculoperitoneal shunt placement, or VP shunting, is a surgical procedure in which your surgeon places a VP shunt inside one of your brain’s ventricles to divert CSF away from the brain and into the peritoneal space of the abdomen or other suitable drainage site in order to reduce pressure and swelling in your brain.
How Does a Ventriculoperitoneal Shunt Work?
A VP shunt is comprised of two small, thin tubes called catheters and a control valve. One end of the upstream catheter (short catheter) is placed in the ventricles. The other end of the downstream catheter (long catheter) is placed in the peritoneal cavity. Both catheters are connected to a valve that controls the flow of CSF. The valve opens when the pressure in the brain gets too high, passing excess fluid from the short catheter to the long catheter. This enables drainage of excess fluid from the brain into the peritoneal cavity, the space in the abdomen where the digestive organs are located. The CSF diverted to the peritoneal space is reabsorbed into the bloodstream and eventually discharged through normal urination.
Preparation for Ventriculoperitoneal Shunt Placement
Preoperative preparation for ventriculoperitoneal shunt placement generally involves the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo blood work and imaging tests to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements you are taking.
- You may need to stop taking vitamin supplements such as Vitamin E, herbal remedies, or medications such as blood-thinners or anti-inflammatories a week or two prior to surgery.
- You should refrain from alcohol or tobacco at least a week before surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Ventriculoperitoneal Shunt Placement
A ventricular peritoneal shunt is inserted under general anaesthesia. Your surgeon makes a small cut behind your ear. A small hole is drilled into the skull, through which a catheter is passed into the brain. Another catheter is placed beneath the skin behind the ear, which is directed towards your chest or abdomen. These catheters drain excess fluid away from the brain and into the abdomen, where it gets absorbed. A valve is connected to both catheters and placed behind your ear. When there is an extra build-up of pressure in the brain, the valve activates automatically, initiating the drainage of CSF.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after ventriculoperitoneal shunt placement will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anaesthetic reactions and monitor your vital signs
- Frequent neurological checks will be performed by your medical staff to assess your brain function as you recover.
- Most patients will require 2 to 3 days of hospital stay.
- You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- Application of cold and heat therapy on the operated area is also recommended to reduce inflammation and pain.
- Moving around in bed and walking are strongly encouraged to prevent the risk of blood clots, pneumonia, and to help induce passing gas and bowel movements.
- Antibiotics are prescribed as needed to address the risk of surgery-related infection.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from smoking and alcohol for a specified period of time as they can negatively affect the healing process.
- Refrain from strenuous activities and lifting anything heavier than 5 pounds until the first follow-up visit.
- Physical therapy and regular walking are recommended to improve strength and endurance after the first follow-up visit.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Ventriculoperitoneal shunt placement is a delicate procedure and may involve the following risks and complications:
- Blood loss
- Blood clots or deep vein thrombosis (DVT)
- Anaesthetic complications
- Swelling of brain tissue
- Damage to the brain
- Re-accumulation of CSF
- Failure of the shunt
- Need for repeat surgery to replace the shunt