Overview
Ventriculoperitoneal shunting is a surgical procedure used to treat hydrocephalus, a condition characterised by the accumulation of excess cerebrospinal fluid (CSF) in the brain's ventricles. This procedure involves the insertion of a ventriculoperitoneal (VP) shunt, a medical device that diverts the fluid away from the brain, relieving pressure and restoring normal CSF flow.
Types of VP Shunt
There are two primary types of VP shunts:
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Programmable VP Shunt
A programmable VP shunt, also known as an adjustable valve, features external and adjustable valves that can be readjusted as needed. Surgeons often prefer programmable valves for placement due to their flexibility and customization options.
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Non-programmable VP Shunt
A non-programmable VP shunt has a pre-programmed valve that activates when the fluid reaches a certain volume. These valves typically have three to five pressure settings, with higher pressure draining less fluid and lower pressure draining more fluid.
When is Ventriculoperitoneal Shunting Surgery Needed?
Surgery for ventriculoperitoneal shunting is necessary when an individual is diagnosed with hydrocephalus. Hydrocephalus can occur in both babies and older adults, and surgery is required to address the underlying cause of fluid accumulation. Several factors can disrupt the normal flow of CSF, leading to hydrocephalus, including blockages in the ventricles, overproduction of fluid, poor fluid absorption by blood vessels, cysts, tumours, inflammation in the brain, infections, and trauma.
When is Ventriculoperitoneal Shunting Surgery Needed?
Surgery for ventriculoperitoneal shunting is necessary when an individual is diagnosed with hydrocephalus. Hydrocephalus can occur in both babies and older adults, and surgery is required to address the underlying cause of fluid accumulation. Several factors can disrupt the normal flow of CSF, leading to hydrocephalus, including blockages in the ventricles, overproduction of fluid, poor fluid absorption by blood vessels, cysts, tumours, inflammation in the brain, infections, and trauma.
Who are the Best Candidates for Ventriculoperitoneal Shunting Surgery?
Individuals diagnosed with hydrocephalus, leading to the excessive accumulation of cerebrospinal fluid in the brain, are the primary candidates for ventriculoperitoneal shunting. In cases where hydrocephalus is present in newborns, immediate treatment with VP shunting is crucial.
Ventriculoperitoneal Shunting Surgery Procedure
The ventriculoperitoneal shunting procedure involves several steps to alleviate the accumulation of excess cerebrospinal fluid. Here is an overview of the surgical process:
- General anaesthesia is administered to ensure the patient remains unconscious and pain-free throughout the surgery.
- Once the patient is under anaesthesia, a breathing tube is placed in the windpipe through the mouth to facilitate breathing.
- The surgical team shaves the patient's hair around the incision sites, which may be located behind the ear, on the top, or back of the head.
- The surgeon makes incisions on the head, neck, and abdomen, and a small hole is drilled in the skull through one of the incisions.
- Three catheters (thin, flexible tubes) are inserted: one in the brain's ventricle, another in the abdomen, and the third attached to the valve placed behind the ear under the skin. The endoscope is commonly used for catheter placement.
- The short catheter inside the brain is connected to one end of the valve, while the long catheter inside the abdomen is connected to the other end of the valve.
- The tube passes down the chest and abdomen, allowing the excess fluid to drain into the abdominal cavity.
- In the case of a programmable shunt, a tiny pump is attached to both catheters and placed under the skin behind the ear. This pump automatically activates when there is increased pressure in the skull due to fluid accumulation.
- After ensuring all the catheters are properly connected, the incisions are stitched and bandaged.
- The entire procedure typically lasts between 60 to 90 minutes.
Possible Complications After Ventriculoperitoneal Shunting Surgery
Although VP shunt treatment is generally safe, there are potential complications that can arise during or after surgery. Some of these complications include:
- Excess bleeding
- Infection or swelling
- Reactions to anaesthesia
- Blood clots in the brain
- Damage to brain tissue
- Intracerebral or intraventricular haemorrhage
- Seizures or loss of coordination and balance
- Vomiting and tiredness
It is important to monitor for symptoms such as fever, fatigue, abdominal pain, or headache, as they may indicate an infection. If any of these symptoms arise, it is essential to notify the doctor immediately.
Taking Care of Yourself After Ventriculoperitoneal Shunting Surgery
Proper post-operative care is crucial for a smooth recovery after VP shunt surgery. Here are some important aspects to consider:
- Recovery typically takes 3 to 4 days, during which the patient may gradually transition from a liquid to a soft food diet.
- It is important to maintain a healthy and well-balanced diet to support healing.
- Mild headaches or discomfort around the incision site may occur, and it is advised to avoid applying lotions or creams to the area.
- Follow the prescribed medication and painkiller regimen as directed by the doctor.
- Sufficient rest is essential for recovery.
- Practice breathing exercises to ensure the lungs expand fully and aid in recovery.
By following these guidelines and seeking regular follow-up care, individuals can optimise their recovery and support the successful outcome of ventriculoperitoneal shunting.
Reviewed & Updated On
Reviewed by Dr Ashish Gupta, Senior Director, Neurosurgery, Spine Surgery on 13-June-2023.