VP Shunt Surgery - Symptoms, Procedure, Risks

A ventriculoperitoneal (VP) shunt is a medical device that relieves pressure on the brain caused by fluid accumulation.

VP shunting is a surgical procedure that primarily treats a condition called hydrocephalus. This condition occurs when excess cerebrospinal fluid (CSF) collects in the brain’s ventricles. CSF cushions your brain and protects it from injury inside your skull. The fluid acts as a delivery system for nutrients that your brain needs, and it also takes away waste products. Normally, CSF flows through these ventricles to the base of the brain. The fluid then bathes the brain and spinal cord before it’s reabsorbed into the blood.

When this normal flow is disrupted, the buildup of fluid can create harmful pressure on the brain’s tissues, which can damage the brain. Doctors surgically place VP shunts inside one of the brain’s ventricles to divert fluid away from the brain and restore normal flow and absorption of CSF.

What is it used for?

Doctors often use a ventriculoperitoneal shunt to treat hydrocephalus, which is also known as water on the brain. Hydrocephalus is a condition where cerebrospinal fluid (CSF) pools in the cavities in a person’s brain.

CSF delivers essential nutrients to the brain and drains away waste. To do this, CSF passes through cavities in the brain called ventricles, bathing the brain in the fluid. It then drains out of the base of the brain, and the blood reabsorbs it.

When a person has hydrocephalus, this process does not happen correctly. Excess CSF pools in the brain ventricles, which increases the pressure on the brain. Hydrocephalus may cause brain damage or death if left untreated.

When a person has hydrocephalus, it may mean that there is:

• An obstruction that stops CSF draining properly


• Overproduction of CSF


• Improper absorption of CSF

The following factors can cause hydrocephalus:

• Genes, meaning it may be inherited


• Head injuries


• Brain tumor


• Stroke


• Brain infection

A person with hydrocephalus may experience the following symptoms:

• Memory problems


• Headaches


• Seizures


• Irritability


• Trouble thinking


• Vision problems


• Loss of bladder or bowel control


• Increased head size


• Poor coordination

VP shunt procedure:

Doctors typically perform the placement of a VP shunt while a patient is under general anesthesia. You’ll be asleep during the surgery and won’t experience pain. The entire procedure takes about 90 minutes.

Speak to your medical care team about preoperative food and drink restrictions. Older children and adults may need to fast for at least eight hours prior to surgery. Infants and toddlers may only need to stop eating baby formula and solid foods six hours before surgery, but they can usually drink water until four hours before the scheduled procedure. In all cases, these instructions should be reviewed with your surgical team.

The surgical nurse will shave the area behind your ear in preparation for shunting, as this is where they will place the catheter. Catheters are thin, flexible tubes used to drain excess fluid. A surgeon will make a tiny incision behind the ear and will also drill a small hole in the skull. They will then thread one catheter into the brain through this opening. The other catheter goes behind your ear and is subcutaneous, meaning it resides under the skin. This tube travels down to your chest and abdomen, allowing excess CSF to drain into the abdominal cavity, where your body absorbs it. Your surgeon may attach a tiny pump to both catheters and place it under the skin behind your ear. The pump will automatically activate to remove fluid when the pressure in the skull increases. It may even be possible to program the pump, also called a valve, to activate when the fluid increases to a certain volume.

Risks and complications:

Going under general anesthetic is safe for most people. But some people may experience adverse effects, including:

• Breathing problems


• Changes to blood pressure


• Changes to heart rate

Sometimes a ventriculoperitoneal shunt may stop working correctly and need replacing. Signs that the device is not working as it should include:

• Redness or swelling where the catheter passes under the skin


• Loss of coordination or balance


• Vomiting without feeling very nauseous


• A headache that will not go away


• Extreme tiredness


• Trouble waking or staying awake


• Feeling irritable

If a ventriculoperitoneal shunt stops working correctly, it is possible for it to over- or underdrain CSF. If the pump drains CSF faster than the body produces it, a person may experience a brain hemorrhage. If the pump does not drain CSF quickly enough, the symptoms of hydrocephalus might return.

It is also possible for the ventriculoperitoneal shunt to become infected. Signs of infection include:

• Redness or swelling where the catheter passes under the skin


• Pain around the catheter


• High fever


• A headache

If a person has any signs of infection, they should see a doctor straight away.

After having a ventriculoperitoneal shunt inserted, a person should avoid coming into contact with magnets. Magnetic fields may affect how the valve on the shunt works.

Sometimes earphones may affect the effectiveness of a ventriculoperitoneal shunt, so it is a good idea to check the shunt manufacturer’s guidelines before using them.

If a person needs to have an MRI scan in the future, they should let the MRI operator know that they have a ventriculoperitoneal shunt.

Similarly, if a person has surgery on their abdomen in the future, they should let the doctor know they have a ventriculoperitoneal shunt.

It is a good idea for a person who has a ventriculoperitoneal shunt to wear a medical bracelet to alert people in case of an emergency.