Ventriculoperitoneal Shunt Placement

The human brain makes ¾ of a liter of water and reabsorbs it through drainage channels every day. If your brain's normal drainage channels are not working properly and water builds up in the brain, the water needs to be sent someplace else. This is when a little plastic tube called a ventriculoperitoneal (VP) shunt is used to let the water flow away from the brain and into a sack in the abdomen called the peritoneum. The peritoneum absorbs this fluid and gets rid of it. A VP shunt is a bypass of fluid from the ventricles of the brain to the peritoneum of the abdomen.

This drainage of fluid is necessary for many reasons. For example, a VP shunt needs to be placed:

  • In young infants who have a bleed or an abnormality in their brain (intraventricular hemorrhage).

  • In young adults after certain kinds of brain bleeds (subarrachnoid hemorrhage).

  • In young woman to prevent headaches and disturbance in their vision (pseudotumor cerebry).

  • In the elderly who have normal pressure but are getting confused, cannot walk, and have urinary incontinence (normal pressure hydrocephalous).

LET YOUR CAREGIVER KNOW ABOUT:

  • Recent infections.

  • Any foreign objects in your body from a previous surgery.

  • Any recent fevers or illness.

  • Past medical history (such as diabetes, seizure disorder, or previous abdominal surgery).

  • Allergies.

  • Medicines taken including herbs, eyedrops, over-the-counter medicines, and creams.

  • Use of steroids (by mouth or creams).

  • Past problems with numbing medicines (anesthetics).

  • Possibility of pregnancy, if this applies.

  • History of blood clots.

  • History of bleeding or blood problems.

  • Past surgery.

  • Other health problems.

  • If you are experiencing changes in your vision.

  • If you are suffering from nausea.

  • If you have any recent onset of headaches.

RISKS AND COMPLICATIONS

  • Bleeding. A large bleed in the brain is not very common but can cause a great deal of damage.

  • Infection.

  • Injury to the structures in the neck, chest, abdomen, or bowel.

  • Hernia at the surgical cut (incision) site in the abdomen.

  • Shunt malfunction or blockage. Infection is a common cause of a shunt not working.

BEFORE THE PROCEDURE

  • You will be given a medicine to help you sleep (general anesthetic), and a breathing tube will be placed.

  • You will be given antibiotic medications to help prevent infection.

  • Your head, neck, chest, and abdomen will be cleaned.

  • Before surgery, half of your head is shaved in the area where the shunt will be inserted.

PROCEDURE

  • Once you are sleeping, a small whole is drilled in the skull for a plastic tube to be placed into one of the pockets of fluid (cerebrospinal fluid) called the ventricles. This tube is small.

  • A small incision is then made over the abdomen. Another plastic tube is passed under the skin of the head, neck, and chest. It is then passed through a hole into the belly.

  • The 2 tubes are connected to a plastic chamber that allows the surgeon to control the flow of water from the brain to the belly with a remote control. This is called a programmable shunt.

AFTER THE PROCEDURE

  • You will most likely spend 24 to 48 hours in the hospital. During this time, your caregiver will look for any signs of complications from the procedure.

  • You will receive antibiotics for 24 hours.

  • Once you start passing gas, your caregiver will allow you to eat.

  • Once you have started eating, walking, urinating, and having bowel movements on your own, and you are not having headaches, nausea, or vomiting, your caregiver may allow you to go home.