Is a Ventriculoperitoneal Shunt?
A ventriculoperitoneal (VP) shunt is a medical device that relieves
pressure on the brain caused by fluid accumulation.
VP shunting is a surgical procedure that primarily treats a
condition called hydrocephalus. This condition occurs when excess cerebrospinal
fluid (CSF) collects in the brain’s ventricles. CSF cushions your brain and
protects it from injury inside your skull. The fluid acts as a delivery system
for nutrients that your brain needs, and it also takes away waste products.
Normally, CSF flows through these ventricles to the base of the brain. The
fluid then bathes the brain and spinal cord before it’s reabsorbed into the
When this normal flow is disrupted, the buildup of fluid can
create harmful pressure on the brain’s tissues, which can damage the brain. Doctors
surgically place VP shunts inside one of the brain’s ventricles to divert fluid
away from the brain and restore normal flow and absorption of CSF.
Needs a VP Shunt?
People of any age can develop hydrocephalus and therefore require
a VP shunt. However, according to the Mayo
Clinic, hydrocephalus is more likely to occur in babies and older adults.
Institute for Neurological Disorders and Stroke (NINDS) estimates that one
to two of every 1,000 babies are born with hydrocephalus.
Excess fluid can build up around the brain for a number of
- overproduction of CSF
- poor absorption of CSF by the blood vessels
- blockages preventing fluid from flowing throughout
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. Symptoms of hydrocephalus can include:
- large head size
- excessive sleepiness
- poor appetite
- cognitive delays or regression
- memory loss
- poor coordination
- impaired vision
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.
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.
Speak to your medical care team about preoperative food and
drink restrictions. Older children and adults must fast for at least 8 hours
prior to surgery. Infants and toddlers may only need to stop eating baby
formula and solid foods 6 hours before surgery, but they can usually drink
water until 4 hours before the scheduled procedure. In all cases, these
instructions should be reviewed with your surgical team.
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 will
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.
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 frequently and your doctor will administer
preventive antibiotics. Your doctor will make sure the shunt is working
properly before you leave.
of VP Shunting
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 can indicate an infection or a malfunction of the shunt.
Notify your doctor immediately if these signs and symptoms develop. According
to the University
of Chicago, infection is most common in the first few weeks after a shunt
Shunting is successful in reducing pressure in the brain in
most people. VP shunts are likely to require replacement after several years,
especially in small children. The average lifespan of an infant’s shunt is 2 years.
Adults and children over the age of 2 may not need a shunt replacement for 8 or
more years. Shunts systems require frequent monitoring and follow-up.
Complications that may occur with shunt systems include:
- mechanical failure
Malfunctions can lead to serious complications, such as
over- or under-draining of CSF. Over-draining occurs when CSF drains from
ventricles at a faster rate than it is produced. This can cause ventricles to
collapse, which may lead to headaches or hemorrhage inside the brain.
Under-draining allows CSF to accumulate on the brain and can cause symptoms of
hydrocephalus to return. Seek immediate medical attention if you experience
symptoms that indicate your shunt system isn’t working properly.