Ventriculoperitoneal Shunt (VP Shunt)

What is a Ventriculoperitoneal Shunt?

A ventriculoperitoneal shunt (also known as a VP Shunt) refers to a device that surgically placed in the brain to drain the excess cerebrospinal fluid(CSF) ¹. Shunt procedure helps to relieve pressure from the brain caused by hydrocephalus. Hydrocephalus occurs when excess cerebrospinal fluid accumulates in the brain’s ventricles. Usually, CSF acts as a cushion and protects the brain from injury inside the skull. Usually, this fluid helps to transport nutrients to the brain and takes away waste materials. The flow of CSF occurs through the ventricles to the base of the brain. Then this fluid spreads to the brain and spinal cord before reabsorption into the blood.

The disruption of normal CSF flow can result in the buildup of fluid inside the cranial cavity and creates harmful pressure on the brain’s tissues. This may lead to damage to the brain. Untreated hydrocephalus can result in various complications such as chronic headache, gait difficulty, mild dementia, and loss of bladder control. Blockage refers to the most common cause of hydrocephalus. Symptoms of hydrocephalus may include large head size, seizure, headache, irritability, memory problems, incontinence, cognitive problems, poor appetite, impaired vision, poor coordination, excess sleepiness, etc. Also, inflammation, cyst, brain tumor impairs the normal flow of CSF and results in the accumulation of CSF ².

Neurosurgeons place VP shunts inside the brain’s ventricles to divert the fluid away from the brain and help to restore the normal flow of CSF. Ventriculoperitoneal shunt collects excess CFS from the brain and drains these into the peritoneal cavity. Usually, a ventriculoperitoneal shunt comprises three parts: a ventricular catheter, a valve, and a peritoneal catheter. The valve connects the ventricular catheter with the peritoneal catheter which placed in the peritoneal cavity ³.

Who is an ideal candidate for Ventriculoperitoneal Shunt?

Peoples of any age can develop hydrocephalus and requires VP shunt for recovery. A recent study shows that every year about 33,000 people performed shunts in the United States. Hydrocephalus most prevalent among babies and older adults. According to the National Institute for Neurological Disorders and Stroke (NINDS), almost 2 of every 1,000 babies develop hydrocephalus by born. The reasons for excess fluid buildup may include ⁴:

• Excess production of CSF
• Poor absorption of CSF
• Disruption of the normal flow of CSF throughout the brain

Neurosurgeons diagnose hydrocephalus by various clinical tests. These tests include ultrasound imaging techniques, CT scans, and MRI scans. These clinical tests allow surgeons to view the inside of the cranial cavity and brain tissues. This helps to detect any abnormalities in the brain like an excessive accumulation of CSF than normal.

How do Neurosurgeons perform Ventriculoperitoneal Shunt?

Ventriculoperitoneal shunt (VP) procedure requires a professional medical team led by an expert neurosurgeon, an anesthesiologist, a vascular surgeon, an anesthesiologist, and nurses to perform successfully. Surgeons require about 1 hour to perform this shunt operation in the operating room. The basic steps include ⁵:

• Anesthesiologists will administer general anesthesia to the patient before surgery to fall asleep, and nurses will prepare the incision site by shaving the incision area.
• Neurosurgeons will make 3 incisions in the brain, neck, and abdomen to guide the catheter so it can be placed correctly.
• Surgeon will also drill a small hole in the skull and then thread one catheter into the brain through this opening. The other catheter goes behind the ear and placed subcutaneously.
• This tube runs through the chest and abdomen and allows excess fluid to drain into the peritoneal cavity.
• Finally, surgeons will close the incisions with stitches or staples.

Afterward, the patient carefully observed for 24 hours. A typical stay of 2 to 4 days requires in the hospital after this operation ⁵. Post-surgical complications can have dire consequences for the patient with shunt operation. The nurse needs to monitor the patient continuously for any signs of these complications during his stay in the hospital. If any complications arise, they need to act immediately.

References

1. Stone, J. J., Walker, C. T., Jacobson, M., Phillips, V. & Silberstein, H. J. Revision rate of pediatric ventriculoperitoneal shunts after 15 years: Clinical article. J. Neurosurg. Pediatr. 11, 15–19 (2013).
2. Park, M. K. et al. A retrospective analysis of ventriculoperitoneal shunt revision cases of a single institute. J. Korean Neurosurg. Soc. 57, 359–363 (2015).
3. Yu, Q., Lou, C., Feng, T. & Liu, Y. Ventriculoperitoneal shunt malfunction due to chronic cholecystitis: A case report. Medicine (Baltimore). 99, e20565 (2020).
4. McGovern, R. A., Kelly, K. M., Chan, A. K., Morrissey, N. J. & Mckhann, G. M. Should ventriculoatrial shunting be the procedure of choice for normal-pressure hydrocephalus?: Clinical article. J. Neurosurg. 120, 1458–1464 (2014).
5. Erol, F. S., Ozturk, S., Akgun, B. & Kaplan, M. Ventriculoperitoneal shunt malfunction caused by fractures and disconnections over 10 years of follow-up. Child’s Nerv. Syst. 33, 475–481 (2017).