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Alternative Names Return to topShunt - ventriculoperitoneal; VP shunt; Shunt revision
Definition Return to top
Ventriculoperitoneal shunt is surgery that is done to relieve pressure inside the skull (intracranial pressure). This pressure is caused by too much cerebrospinal fluid (CSF) on the brain (hydrocephalus). The fluid is drawn off (shunted) from the ventricles in the brain into the abdominal (peritoneal) cavity. In rare cases the fluid is shunted into the pleural space in the chest (the thin covering of the lungs).
Description Return to top
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. An incision or cut in the shape of a horseshoe is made behind the ear. Another small incision is made in your 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 tunneled under the skin from behind the ear, down the neck and chest, and most of the time into the abdominal cavity. Sometimes this catheter goes to the heart. Sometimes, the doctor makes a small cut in the neck to help thread 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 in the head, fluid is directed to the valve and then drains from inside the head down to the belly or the heart.
The valves in newer shunts can be programmed to drain more or less fluid from the brain.
Why the Procedure is Performed Return to top
In hydrocephalus, there is a buildup of fluid of the brain and spinal cord (cerebrospinal fluid or CSF). This buildup of fluid causes pressure on the brain tissue. 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 Return to top
Risks for any anesthesia are:
Risks for any surgery are:
Possible risks of ventriculoperitoneal shunt placement are:
Before the Procedure Return to top
If the procedure is not an emergency (planned surgery):
Ask your doctor or nurse about eating and drinking before the surgery. The general guidelines are:
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 Return to top
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) Return to top
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 Return to top
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.Update Date: 1/12/2009 Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.