VENTRICULOPERITONEAL SHUNTS

What is a Ventriculoperitoneal Shunt?

A ventriculoperitoneal shunt (VP shunt) refers to a surgically implanted device in the brain that drains excess cerebrospinal fluid (CSF) (Barnes, Jones, Hayward, Harkness, & Thompson, 2002). The shunt relieves hydrocephalus-related pressure on the brain. Excess cerebrospinal fluid builds up in the brain’s ventricles, causing hydrocephalus. CSF protects the brain from harm inside the skull by acting as a cushion. Normally, this fluid aids in transferring nutrients to the brain and helps in the removal of waste. CSF travels from the ventricles to the base of the brain, then travels from the brain to the spinal cord before absorbing into the bloodstream.

During disruption of normal CSF flow, the fluid can build up inside the cranial cavity, putting severe pressure on the brain’s structures. This might result in brain damage. While left untreated, hydrocephalus can lead to a variety of consequences, including persistent headaches, gait difficulties, mild dementia, and loss of bladder control. Blockage of CSF results in the most prevalent cause of hydrocephalus. Symptoms of hydrocephalus include seizures, headaches, irritability, large head size, memory issues, incontinence, decreased eyesight, poor coordination, and excessive tiredness. Inflammation, cysts, and brain tumors also obstruct the normal flow of CSF, resulting in CSF buildup (Paff, Alexandru-Abrams, Muhonen, & Loudon, 2018).

Inside the brain’s ventricles, neurosurgeons insert VP shunts to channel fluid away from the brain and assist restore normal CSF flow. The ventriculoperitoneal shunt collects excess CFS from the brain and empties it into the peritoneum. Three components of a ventriculoperitoneal shunt include a ventricular catheter, a valve, and a peritoneal catheter. The valve helps to connect the ventricular catheter with the peritoneal catheter.

Who is an Ideal Candidate for a Ventriculoperitoneal Shunt?

People of any age can develop hydrocephalus, which necessitates the use of a VP shunt to recover. According to recent research, around 33,000 people in the United States receive shunts each year (Barnes et al., 2002). Hydrocephalus affects around two out of every 1,000 newborns, according to the National Institute of Neurological Disorders and Stroke (NINDS) (Hamdan, 2018). A variety of factors such as poor absorption of CSF, excessive CSF production, disruption of CSF flow can cause hydrocephalus. Various clinical tests such as ultrasound imaging techniques, CT scans, and MRI scans help neurosurgeons to diagnose hydrocephalus. These diagnostic tests help to observe the interior of the cranial cavity and brain tissues of patients. This aids in the detection of any abnormalities in the brain, such as an abnormally high amount of CSF (Goeser, McLeary, & Young, 1998). 

Complications can arise during or after the operation. The most common complications of VP shunt operation include excessive bleeding, hematoma, brain tissue damage, swelling of the brain, risk of infection, etc. Also, patients can develop some side-effects of general anesthesia such as breathing problems, changes in heart rate, and variations in blood pressure levels. Patients may require replacement or reprogramming of an already existing shunt. In small children, Neurosurgeons need to replace VP shunts after a few years. An infant’s shunt has a two-year average lifetime. Adults and toddlers over the age of two may not require a shunt replacement for at least eight years. These VP shunt systems require regular monitoring and follow-up by neurosurgeons. 

How do Neurosurgeons Insert a Ventriculoperitoneal Shunt?

A professional medical team led by a qualified neurosurgeon, anesthesiologist, vascular surgeon, and nurses perform Ventriculoperitoneal Shunt (VPS) surgery. This shunt surgery takes roughly an hour for surgeons to complete in the operating room. The steps of this surgery include the following: 

  • Before surgery, anesthesiologists will give the patient a general anesthetic to put them to sleep, and nurses will prepare the incision site by shaving it.
  • Neurosurgeons will create three incisions in the brain, neck, and abdomen to guide the catheter into the precise position.
  • Also, the neurosurgeon will create a tiny hole in the skull to thread one catheter into the brain and place the other catheter subcutaneously behind the ear.
  • Finally, surgeons will cover the incisions with stitches or staples. This tube passes through the chest and abdomen and permits excess fluid to drain into the peritoneal cavity.

Following that, nurses carefully monitor the patient for the next 24 hours. After this procedure, the patient needs to stay in the hospital for 2 to 4 days (Kumar et al., 2020). During the patient’s stay in the hospital, the nurse must keep a constant eye on the patient for any issues. Nurses must respond immediately if any issues occur. With the help of a shunt, many persons with normal pressure hydrocephalus may live a normal life. For more information, please contact us.

References

Barnes, N. P., Jones, S. J., Hayward, R. D., Harkness, W. J., & Thompson, D. (2002). Ventriculoperitoneal shunt block: What are the best predictive clinical indicators? Archives of Disease in Childhood, 87(3), 198–201. https://doi.org/10.1136/adc.87.3.198

Goeser, C. D., McLeary, M. S., & Young, L. W. (1998). Diagnostic Imaging of Ventriculoperitoneal Shunt Malfunctions and Complications. Radiographics, 18(3), 635–651. https://doi.org/10.1148/radiographics.18.3.9599388

Hamdan, A. R. (2018). Ventriculoperitoneal shunt complications: a local study at Qena University Hospital: a retrospective study. Egyptian Journal of Neurosurgery, 33(1). https://doi.org/10.1186/s41984-018-0008-5

Kumar, P., Pandey, S., Bhakal, N., Shrivastava, S., Gupta, L. N., & Jha, R. P. (2020). A Retrospective Study on Ventriculoperitoneal Shunt Complications in a Tertiary Care Centre. Indian Journal of Neurosurgery, 9(03), 170–174. https://doi.org/10.1055/s-0040-1713562

Paff, M., Alexandru-Abrams, D., Muhonen, M., & Loudon, W. (2018). Ventriculoperitoneal shunt complications: A review. Interdisciplinary Neurosurgery: Advanced Techniques and Case Management, 13(June 2017), 66–70. https://doi.org/10.1016/j.inat.2018.04.004

ABOUT LONGHORN BRAIN & SPINE

Founded on Excellence

Founded by Neurosurgeon, Dr. Grant Booher, Longhorn Brain and Spine focuses on a patient-centered approach to alleviating North Texans from Neurological and Spinal Pain.  Dr. Booher and his clinical team believe in exhausting all non-invasive protocols first and if needed, employing the least invasive procedures necessary to treat the patients.

Our Beliefs

Dr. Booher believes in a conservative, individualized and holistic approach when it comes to his patients. He prefers exhausting all nonsurgical options and proudly offers the least invasive techniques when clinically indicated. He strives to treat every patient like a member of his family. During his free time, he and his wife enjoy watching sports, listening to Texas country music, and traveling.