shunt is used to take excess fluid from the ventricles (fluid
filled cavities) within the brain, and "shunt" or
divert it to the abdomen for absorption. Normally, the
brain produces about 500 cc (half a liter) of cerebrospinal
fluid (CSF) per day, and it is absorbed back into the blood
by filtration into the superior sagittal sinus and other veins
in the brain. At times, the filtration process may become
partially obstructed, and the fluid may build up, causing
pressure on the brain. This is known as hydrocephalus.
There may be a number of causes of the build up of fluid.
Hemorrhage in the CSF, or meningitis (an infection of the
CSF) may cause the drainage channels into the superior sagittal
sinus to become "clogged," and the fluid which is
produced cannot be easily reabsorbed into the blood.
A tumor or other mass lesion may be obstructing the normal
circulation patterns of CSF within the brain, and this may
lead to hydrocephalus. Or, sometimes in the elderly,
CSF builds up in the ventricles within the brain, and the
patient may suffer from a condition known as normal pressure
hydrocephalus (NPH). Regardless of the reason for the
hydrocephalus, a ventriculoperitoneal shunt allows the excess
CSF to be channeled into the abdomen, from where it is absorbed
back into the blood.
a ventriculoperitoneal (VP) shunt procedure, a small hole
is made in the skull, and a tube is passed into the ventricle
within the brain. The tube (known as a ventricular catheter)
is connected to a valve, which in turn is connected to another
tube which is tunneled beneath the skin, and the end is placed
within the abdomen. The valve regulates the pressure
at which the shunt will divert fluid from the brain.
The valve may be either fixed in its opening pressure (the
pressure above which fluid will drain from the brain into
the abdomen), or it may be programmable. A programmable
valve will give the surgeon the ability to postoperatively
adjust the pressure for which fluid will be shunted.
Often, a general surgeon will perform the abdominal portion
of the procedure. The tube is passed from the head to
the abdomen, beneath the skin. There may be one or more
incisions along the path of the shunt, to help pass it to
shunts are placed relatively frequently. Yet, there certainly
are risks to the procedure. Risks can be broken down into
two categories, 1) those related to the operative site, and
2) those related to the risks of anesthesia.
related to the operative site:
Exposure: The patient is placed in a supine position
(on their back). In this position,
there can be pressure sores and pressure injuries to nerves.
A hole is made in the skull and a catheter inserted into
the brain. There can be bleeding in the area of the
tube, in the brain and drill hole, potentially requiring
emergent surgery to make a larger opeining in the skull
for clot removal. There may be difficulty getting
the catheter into the ventricle, and several "passes"
of the tube may be needed. If the catheter "irritates"
the brain, seizures may occur. The distal (bottom
portion) of the catheter is placed within the abdomen.
There could be injury to the bowel, and infection may occur.
The wounds could have difficulty with proper healing.
Risks: These include general difficulties,
such as bleeding, infection, stroke, paralysis, coma and
death. Incisions in the scalp and abdomen generally
heal well, but there may be tenderness and numbness, or
the wounds may heal in an unpleasant manner. There
is also the possibility that the surgery may not relieve
the symptoms for which the procedure was performed.
The problem for which the surgery was performed may recur,
requiring additional surgery in the future. If the
shunt drains too much CSF, if is possible that the brain
could "collapse" around the shunt tube, with fluid
or blood developing around the brain. This may require
an operation to remove the fluid or blood around the brain. The
abdominal portion of tubing could pull out of the abdomen,
or could become walled off in a cystic area, requiring surgery
for repositioning. The tubing may deteriorate and
break over time. The valve and tubing may malfunction
or become clogged, requiring a revision of the shunt.
In addition, although every attempt is made to protect all
areas of the body from pressure on nerves, skin and bones,
injuries to these areas can occur, particularly with prolonged
Blood clots in the legs, heart attacks, reaction to the
anesthetic, reaction to blood transfusion, if given.
shall be no bending, twisting, or heavy lifting for several
weeks after surgery. Your doctor will
gradually ease your work restrictions, depending on your
to keep the wound dry and clean. Notify your surgeon
of any drainage or temperatures greater than 101 Fahrenheit.
following is a list of suggestions that should help speed
your recovery and give you every possible chance for the
best results from your surgery.
upon discharge, contact our office and set up an appointment
for staple removal if one has not already been made.
it easy until seen by the physician. This does not
mean bed rest, but athletic activities during this period
are definitely not recommended. Please give your
incisions a chance to heal.
jogging or running.
driving until OK with your physician.
may shower after you go home unless otherwise instructed.
Cover the incisions with plastic wrap before the shower
and remove it afterward. Change dressing immediately.
Tub baths are not advisable. You may shower without
covering the incision one week after the staples are out.
Follow instructions concerning care of tape strips, stitches
or staples. Your surgeon or nurse clinician will
explain the techniques used in the closure of your incision.
activities are permitted.
you notice swelling, redness or opening of the incision,
or if there is any clear fluid draining from it, please
contact your surgeon immediately! If you develop
a fever, stiff neck or chills, contact the office immediately.
Take your temperature at 4:00 PM daily until the clips
are removed. Call if greater than 101 degrees Fahrenheit.
If you have any questions, call our office, and for after
hours emergencies, call the after hours number.
your medications prescribed on discharge, as directed.