VP Shunt

Hydrocephalus affects over 1 million Americans of all ages, ranging from newborns and older children to young and middle-aged adults, as well as older adults. The term hydrocephalus came from the Greek words "hydro" (water) and "cephalus" (head), which translates to "water on the brain." Hydrocephalus is a neurological condition that refers to the abnormal buildup of cerebrospinal fluid (CSF), a clear organic liquid surrounding the brain and spinal cord. This excess CSF can cause the ventricles to widen and put harmful pressure on the brain's tissues confined within the skull.

The constantly circulating CSF has many functions. It acts as a cushion or shock absorber for the brain and spinal cord, delivering nutrients to the brain while removing waste. It flows between the cranium and spine to regulate changes in pressure.

Excess buildup of this fluid can cause brain damage or even death. Hydrocephalus may be present at birth or may result from damage or injury. Some of the causes of hydrocephalus include:

• Spina bifida – a condition characterized by an underdeveloped spinal cord in babies
• Aqueductal stenosis – a condition that occurs when the CSF flow between the ventricles inside the brain is blocked
• Infection during pregnancy
• Complications of prematurity (being born early)
• Bleeding in the brain (from a stroke or brain injury)
• A brain tumor
• Infection in the brain

Hydrocephalus has no cure but is treatable with early detection and appropriate intervention. Ventriculoperitoneal shunt placement is the most common treatment for hydrocephalus.

What Is a Shunt?

A ventriculoperitoneal shunt or VP shunt is a thin, flexible plastic tube placed into the area of the brain where there is CSF buildup. The shunt drains the brain's excess fluid, which causes harmful pressure on brain tissues. It diverts the excess brain fluid from the brain's ventricles into the space in the abdomen that houses the digestive organs, called the peritoneal cavity. The other types of shunt systems are:

• VA (ventriculoatrial) shunt – diverts the excess brain fluid from the brain into the heart. The process involves placing the distal catheter into a vein in the neck to gently advance the fluid into the right atrium.
• VPL (ventriculopleural) shunt – diverts the excess brain fluid into the space between the chest wall and the lungs, called the pleural or chest cavity.
• LP (lumboperitoneal) shunt – diverts the excess brain fluid from an area in the spine, called the intrathecal space rather than the brain, into the body's cavity that houses the digestive organs.

A shunt consists of a ventricular catheter connected to a valve that helps regulate the amount of fluid that leaves the brain. The type of valve used depends on a patient's age, ventricle size, amount of pressure that needs to be relieved and other important clinical factors. The two types of valves are:

• Fixed pressure valve – regulates the pressure within the brain through a one-way valve. Fixed pressure valves use a predetermined setting which means additional surgery is required to implant this type of valve
• Adjustable (programmable) valve – regulates the pressure in the brain using the same pressure setting as fixed pressure valves. However, programmable valves enable a neurosurgeon to adjust the valve pressure setting using an external adjustment tool without surgery

How Do VP Shunts Work?

Shunt tubing is an effective treatment option for hydrocephalus as it runs underneath the skin and into another part of the body to allow CSF absorption. By doing this, shunt tubing relieves the pressure on the brain. Although shunt systems, such as VP shunt placement, successfully manage hydrocephalus, patients will need a shunt for the rest of their lives. They will also need regular monitoring by a neurosurgeon throughout their lifetime.

How Long Does VP Shunt Surgery Take?

Neurosurgeons perform shunt surgery placement in the operating room with the patient under general anesthesia, which usually takes one to two hours.

What To Expect After VP Shunt Surgery?

After a VP shunt surgery, patients usually recover almost entirely after treatment and have a good quality of life. However, there are cases when shunt systems fail to properly drain the fluid due to mechanical failure or infection and cause symptoms to recur. When this happens, the clogged shunt system is replaced with a new one to prevent CSF buildup in the brain.

Seek medical help immediately if the following signs and symptoms appear that may indicate a malfunctioning shunt system:

• Headache
• Double vision or sensitivity to light
• Nausea or vomiting
• Soreness of the neck or shoulder muscles
• Seizures
• Redness or tenderness along the shunt tract
• Low-grade fever
• Sleepiness or exhaustion
• Reoccurrence of hydrocephalus symptoms

Recommendations

The success of shunt placement varies from person to person. Patients who have undergone VP shunt placement require monitoring and regular checkups. Shunts may also be replaced or repaired multiple times in a person's lifetime. However, the benefits outweigh the risks that come with VP shunt placement. As for most conditions, early is key in treating hydrocephalus. The earlier the intervention, the better the chance for successful treatment. Shunts successfully reduce pressure in the brain for most people and allow them to live full lives.