Ventriculoperitoneal (VP) shunt insertion is an operation
performed to place a catheter into a brain ventricle
to drain excessive cerebrospinal fluid (CSF) from the
ventricular system into the peritoneal space in the
abdomen. Usually VP shunts are placed to treat hydrocephalus
(hydro = water, cephalus = head). Many different diseases
block the flow of CSF through the brain, including:
brain tumours, subarachnoid hemorrhage, meningitis,
and head injury. Many cases of hydrocephalus are congenital
- they are caused by improper development of the CSF
pathways. This is not necessarily mean that the rest
of the brain is malformed.
The most common treatment for hydrocephalus is a shunt
- a thin plastic tube inserted entirely under the skin
that creates a new path for the CSF, from the brain
to another part of the body. Shunts are not perfect,
they may malfunction, clog, or break. One problem with
shunts has been infection. Shunts are made of foreign
material, and thus are more prone to infection than
normal body tissue. Many studies suggest that shunt
infections are due to microscopic contamination at the
time of implantation. Shunt infection rates in the 1990's
were often reported to be in the 5-9% range, far higher
than for other implanted foreign bodies, such as pacemakers
or joint replacements.
Size of patient: Ventriculoperitoneal shunts are most
often inserted (and revised) in children. The size of
the patient is important because of the size of the
instruments that must be used, the size of the devices
that are implanted, and because of the limited blood
volume of the smallest patients (premature infants)
who undergo these procedures.
Length of procedure: In patients who have never had
a VP shunt inserted before, a shunt can usually be inserted
in less than an hour. It is important to try to do the
procedure as quickly as possible to minimize the risk
of infection (the most common complication of VP shunt
insertion). The procedure can be done in an hour or
Two body cavities must be entered during the procedure:
the ventricle and the peritoneum. Some surgical teams
find it more efficient to have one surgeon open the
head and catheterize the ventricle at the same time
that a second surgeon opens the abdomen into the peritoneal
Foreign bodies: The ventricular catheter, valve, and
peritoneal tubing are all foreign bodies that can harbor
bacteria introduced by contamination at the time of
surgery or subsequently by seeding of organisms introduced
into the blood stream by a variety of surgical and non-surgical
mechanisms unrelated to the VP shunt insertion procedure.
Insertion of a ventriculoperitoneal shunt takes approximately
1 1/2 hours.
After VP shunt insertion the patient is usually taken
to Recovery. Immediately post-operatively the patient
is monitored for signs of neurologic deficit for a duration
of approximately an hour. Once recovered, in the absence
of any apparent complication, they are taken to a regular
A follow up CT (or MR) is sometimes obtained to verify
that the ventricular catheter tip is located at the
desired location in the anterior horn of the lateral
ventricle close to the foramen of Monro.
Most patients are discharged the morning after an uncomplicated
VP shunt insertion.
The abdominal and scalp incisions usually heal within
7 days after which time the patient can get them wet.
Patients can usually return to work within two weeks
of VP shunt insertion.
Rehabilitation may be required for patients with serious
long term disability resulting from their hydrocephalus
-- the disability in most of these patients will neither
worsen nor improve with shunting.
Most patients with uncomplicated VP shunt insertion
are sent home the day after surgery with a prescription
for pain medication and possibly for an oral antibiotic
to be taken for 7 to 10 days.
After discharge from the post surgical unit the patient
following VP shunt insertion should be seen in the Outpatient/Ambulatory
Clinic 7 to 10 days post-operatively for suture or staple
removal and wound check.
Revision (re-operation for removal or adjustment or
one or all components of) a ventriculoperitoneal shunt
system is one of the most common procedures done by
neurosurgeons (particularly those who operate on large
numbers of children).
Risks & complications
- Tunneling device tip through skin
- Intestinal injury
- Parenchymal placement
- Subdural hematoma
The prognosis depends on the condition for which the
patient was shunted and their neurologic status at the
time of operation.
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