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Ventriculoperitoneal Shunt
A ventriculoperitoneal (VP) shunt is a surgical device used to relieve pressure on the brain caused by fluid accumulation, known as hydrocephalus.
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Dr Keith Goh
What is a Ventriculoperitoneal Shunt
A ventriculoperitoneal (VP) shunt is a surgical device used to relieve pressure on the brain caused by fluid accumulation, known as hydrocephalus. Hydrocephalus occurs when an excess of cerebrospinal fluid (CSF) accumulates in the ventricles, or cavities, of the brain, leading to increased intracranial pressure. This pressure can cause a range of symptoms and, if untreated, can lead to serious brain damage.
Indications for a Ventriculoperitoneal Shunt
The primary indications for a VP shunt include:
- Congenital Hydrocephalus: This condition is present at birth and can be caused by a variety of factors, including genetic predisposition or abnormal malformations, e.g. aqueduct stenosis. In these cases, a VP shunt helps to manage CSF volumes by diverting fluid to the abdomen, thereby preventing complications associated with increased intracranial pressure.
- Acquired Hydrocephalus: Hydrocephalus may develop later in life due to various medical conditions. Common causes include intracranial haemorrhage, infections such as meningitis, trauma or brain tumours. A VP shunt in these situations relieves high fluid pressure and prevents further damage to brain tissue.
- Normal Pressure Hydrocephalus (NPH): NPH is more common in older adults and can lead to symptoms such as difficulty walking, memory loss, and loss of bladder control. The insertion of a VP shunt can alleviate these symptoms by regulating the flow of CSF.
- Obstructive Hydrocephalus: This occurs when the normal flow of CSF is blocked, often by a tumour or structural abnormalities in the brain. A VP shunt bypasses the obstruction, allowing for normal drainage of CSF.
- Communicating Hydrocephalus: For this type of hydrocephalus, CSF is not absorbed efficiently into the bloodstream. The VP shunt procedure aids in directing the excess fluid to the peritoneal cavity, where it can be absorbed.
Preparing for a
Ventriculoperitoneal Shunt
Preparation for a VP shunt involves several steps to ensure the safety and effectiveness of the procedure.
- Preoperative Assessment: Patients undergo a comprehensive medical evaluation, including neurological exams and imaging studies such as MRI or CT scans. This assessment helps in planning the surgical procedure and identifying potential risks.
- Discussion of Medical History: Patients should discuss their complete medical history with their neurosurgeon or specialist. This includes previous surgeries, current medications (especially blood thinners), and allergies.
- Medication Management: Certain medications, particularly blood thinners and antiplatelet agents, may need to be stopped or adjusted before the surgery to reduce the risk of bleeding.
- Fasting Before Surgery: Patients are usually required to fast (not eat or drink) for 4-6 hours before the surgery, so as to reduce the risk of aspiration during anaesthesia.
- Skin and scalp preparation: Hair wash and shower with antiseptic soap or solution is best, so as to reduce the risk of shunt infection from skin contaminants.
- Arranging for Postoperative Care: Plan for recovery, including arranging transportation home and assistance during the initial recovery period. Patients may require assistance with surgical wound care, daily activities and attending follow-up appointments.
Ventriculoperitoneal Shunt Procedure
The procedure to insert a VP shunt typically includes the following steps:
- Anaesthesia: The patient usually receives general anaesthesia, ensuring they are asleep throughout the surgery.
- Preparation of the Surgical Area: A specific small area of hair on the head is sometimes shaved, which could be behind the ear or on the top or back of the head, depending on the surgical plan.
- Incisions: The neurosurgeon makes a skin incision behind the ear and another small surgical cut in the belly. These incisions are necessary for the placement of the catheter.
- Drilling and Catheter Insertion: A small hole is drilled in the skull, and one end of the catheter is passed into a ventricle of the brain. A second catheter is placed under the skin, starting behind the ear and tunnelled down the neck and chest areas, usually into the peritoneal cavity of the abdomen.
- Valve Placement: A valve is positioned underneath the skin, typically behind the ear, and connected to both catheters. This valve regulates the flow of CSF. It opens to drain excess fluid into the belly or chest area when intracranial pressure builds up.
- Closing the Incisions: The incisions are closed with stitches or staples.
Recovery and Rehabilitation
Following the procedure, recovery typically involves a short hospital stay for monitoring, post-operative scan and management of any immediate postoperative complications, especially infection and brain hemorrhage. The recovery period varies, with many patients resuming normal activities within a few weeks.
Rehabilitation focuses on managing discomfort at the incision sites, monitoring for signs of infection, hemorrhage or shunt malfunction, and gradually returning to daily activities. The neurosurgeon will typically provide specific guidelines tailored to each patient’s condition and recovery.
Regular follow-up appointments can help assess the shunt’s function and the patient’s overall well-being, ensuring a smooth transition back to daily life.
Benefits of a Ventriculoperitoneal Shunt
The implantation of a VP shunt offers several benefits for patients suffering from hydrocephalus.
- Reduction of Intracranial Pressure: The primary benefit of a VP shunt is the effective reduction of intracranial pressure caused by excess cerebrospinal fluid (CSF). This can help in reducing the risk of brain damage and supporting brain function.
- Alleviation of Symptoms: Symptoms of hydrocephalus, such as headaches, nausea, vomiting, blurred vision, balance problems, and cognitive difficulties, are often reduced following shunt placement.
- Adjustable Treatment: In cases where a programmable shunt is used, the neurosurgeon can adjust the rate of CSF drainage according to the patient’s changing needs, offering a customised treatment approach.
- Long-term Solution: While not a cure, a VP shunt is a long-term solution that can manage hydrocephalus for many years, often for the patient’s lifetime.
Risks and Complications
While the surgery for implementing a VP shunt is a common procedure, as with any surgery, it carries potential risks and complications.
- Infection: This is the most common complication, especially within the first few months after surgery. Infections require prompt treatment, often with antibiotics and sometimes surgery to replace the infected part of the shunt.
- Shunt Malfunction: The shunt may become blocked, leading to symptoms of hydrocephalus. Signs of a malfunction include headaches, nausea, vomiting, and changes in consciousness. Shunt malfunction requires surgical repair or replacement.
- Over-Drainage or Under-Drainage: Over-drainage can lead to headaches, dizziness, and subdural hematomas (bleeding in the brain). Under-drainage may not alleviate the symptoms of hydrocephalus. Adjustments of the shunt valve or surgery may be necessary to correct drainage issues.
- Abdominal Complications: In rare cases, the part of the shunt in the abdomen can lead to problems such as hernias, cyst formation, infections, or abdominal pain.
Mount Elizabeth Medical Centre,
#09-10, 3 Mount Elizabeth
Singapore 228510
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Mount Elizabeth Medical Centre,
#09-10, 3 Mount Elizabeth
Singapore 228510
Frequently Asked Questions (FAQ)
How Long Does a Ventriculoperitoneal Shunt Last?
The lifespan of a VP shunt can vary depending on several factors, including the patient’s age, the type of shunt, and individual health conditions. While a VP shunt can function effectively for many years, some patients, especially growing children, may require replacement or adjustment to a longer tubing. Regular follow-up with a neurosurgeon can help monitor the shunt’s functionality and make any adjustments as needed.
Can You Live a Normal Life with a Ventriculoperitoneal Shunt?
Many patients with a VP shunt lead full and active lives. The shunt reduces the symptoms of hydrocephalus, allowing for a better quality of life. Although certain lifestyle adjustments may be necessary, many patients with a VP shunt can engage in a wide range of activities, observing precautions as advised by their neurosurgeon.