VP Shunt

Listed below is the step by step procedure of VP shunt surgery:

1. What is VP Shunt?
2. Why is VP Shunt Required?
3. Pre-operative Preparation
4. Day Before Surgery
5. Procedure Day
6. Methods/Techniques of VP Shunt
7. Post Procedure
8. Risks and Complications
9. FAQs

What is VP Shunt?

A hollow tube placed in the brain by surgical method is known as a shunt. It is occasionally placed in the spine and helps in draining cerebrospinal fluid. This fluid is then redirected to other areas in the body where re-absorption is possible. Ventriculoperitoneal shunt (VP Shunt) is a surgery for treatment of excess cerebrospinal fluid (CSF) in the brain.

Why is VP Shunt Required?

In case of planned VP shunt procedure, patients need to inform surgeon about medications they are taking along with the supplements. Any medication suggested by the surgeon, needs to be taken with a small sip of water.

Pre-operative Preparation

In case of planned VP shunt procedure, patients need to inform surgeon about medications they are taking along with the supplements. Any medication suggested by the surgeon, needs to be taken with a small sip of water.

Day Before Surgery

Eating and drinking restrictions are provided to the patients. Patients need to follow these restrictions strictly. Failing to do so can result in cancellation of surgery. Patient medication record needs to be kept handy to avoid complications during surgery. Patient needs to inform the surgeon about any known allergies of medications, anesthesia as well as latex. This helps in reducing possibility of complications during and after shunt process.

Procedure Day

Before the start of surgery, patients need to maintain cleanliness. All instructions given by surgeon need to be followed. Close relatives or friends of the patient are advised to accompany the patient prior to and after the surgery. This helps in reducing anxiety in the patients. Jewelery and contact lenses along with other valuables need to be kept away before start of the surgery.

Methods/Techniques of VP Shunt

Ventriculoperitoneal shunting or VP Shunt is carried out in an operation theater using general anesthesia. It usually continues for 1 to 1 ½ hrs.

The process of VP shunt has following steps.

1. Shaving of an area on the head is carried out. This area can be on the top or back of the head or behind the ear of the patient
2. An U-shaped cut is done by the surgeon behind the ear of the patient. One more cut is made in the abdomen of the patient.
3. In the skull of the patient, a small hole is drilled and a catheter ( a thin tube) is inserted into a brain ventricle. This process is performed with or without computer-assistance. In some cases, an endoscope is used for getting a clear view inside the brain ventricle.
4. Under the skin behind the ear, one more catheters are inserted and sent to the neck and the chest and into abdominal area. In cases, where it gets stopped at the chest, small incision is made by the surgeon so that it gets positioned in right manner.
5. Underneath the skin behind the ear, a fluid pump is placed. This is connected with both catheters. This fluid pump opens when excess pressure builds up around the brain. Excess fluid gets drained into the chest and abdomen area via catheter. As a result of this, intracranial pressure gets reduced.
6. Patient is moved to the recovery room after completion of surgery.

Post Procedure

Post procedure, patient will be monitored for 24 hours.

In general, two to four days of hospitalization is required. It is very essential to attend follow up appointments. It helps in relieving the symptoms of hydrocephalus and also ensures proper working of the shunt. Additionally, physical and occupational therapy along with rehabilitation is recommended to the patients after VP shunt. This helps in early recovery.

Post surgery, there can be tenderness in the neck and abdomen of the patient. Headache can be experienced by the patients after few weeks of surgery. Patients feel tired, but there will not be much pain. Movements of fluid around the scalp can be felt by the patients; which is common. As the scalp gets healed, these feelings will not last.

In cases where tenderness near stitches and staples is experienced, surgeon can remove them after 5-10 days post surgery. There will not be limitation on the activities of the patients as such because of shunt. In some patients, surgeon needs to adjust the shunt valve for drainage of right amount of fluid.

When shunt is not working properly, signs such as infection can be seen. If shunt is not working properly because of infection or stops working, it needs to be replaced. A properly working shunt can be left in place for many years.

Risks And Complications

Risks associated with ventriculoperitoneal shunt placement are listed below.

• Leakage of CSF fluid under the skin
• Blood clot or bleeding in the brain
• Brain swelling
• Seizures
• Bowel perforation (hole in the intestines)
• Brain infection
• Abdomen infection
• Infection of the shunt
• Damage to brain tissue
• Seizures

FAQs

1. What is the success rate of ventriculoperitoneal shunting?

   A. The success rate of ventriculoperitoneal shunting varies from patient to patient. It has been reported in medical literature that 50% cases fail after ventriculoperitoneal shunting. Surgical revision is required in most of the cases. Endoscopic third ventriculosotomy (ETV) is used as an alternative to it and has shown good success rate. Though it is the case, ETV can be used in selected patients only.

2. What happens if there is over- or under-draining of CSF using VP shunt?

   A. Upon underdraining, CSF gets accumulated on the brain and can make recurrence of hydrocephalus. In case of over-draining using VP shunt, CSF gets drained from the ventricles at high speed than it gets formed. Patients need to inform the surgeon about any unusual symptoms they are suffering from. This helps in early treatment and working of VP shunt is also monitored.

3. How much is the life span of VP shunts?

   A. It is not easy to confirm the exact life span of VP shunts. Some medical practitioners predict that after 6 years, approximately half of the VP shunts need to be checked or replaced.