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Ventriculoperitoneal Shunt

Medically reviewed by Suzanne Falck, M.D., FACP — By Erica Roth — Updated on October 11, 2017

Causes

Procedure

Recovery

Risks

Outlook

What is a ventriculoperitoneal shunt?

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.

Who needs a VP shunt?

People of any age can develop hydrocephalus and therefore require a VP shunt. However, according to
the Mayo Clinic, hydrocephalus is more likely to occur in babies and older adults. The National Institute
for Neurological Disorders and Stroke (NINDS)Trusted Source estimates that 1 to 2 of every 1,000 babies
are born with hydrocephalus.

Excess fluid can build up around the brain for a number of reasons, including:

overproduction of CSF

poor absorption of CSF by the blood vessels

blockages preventing fluid from flowing throughout the brain

Blockages are the most common cause of hydrocephalus. Cysts, tumors, or inflammation in the brain
can impede the normal flow of CSF and create an unsafe accumulation. Symptoms of hydrocephalus can
include:

large head size

headaches

seizures

irritability

excessive sleepiness

incontinence

poor appetite

cognitive delays or regression

memory loss

poor coordination

impaired vision

Imaging tests can confirm the diagnosis of hydrocephalus. Ultrasound, CT scans, and MRI scans allow
doctors to view the cavities and tissues within the brain. Testing will show if areas of the brain contain
more fluid than normal.
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.

Recovery

Recovery from a VP shunt placement takes three to four days. Most people can leave the hospital within
seven days after the procedure.

During your hospitalization, the hospital staff will monitor your heart rate and blood pressure, and your
doctor will administer preventive antibiotics. Your doctor will make sure the shunt is working properly
before you leave.

Risks of VP shunting
Placement of a shunt is a very safe procedure. However, complications can occur during or after the
procedure. Risks associated with any surgical procedure include excessive bleeding and infection. You
might also experience adverse reactions to anesthesia, such as breathing difficulties, changes in heart
rate, or changes in blood pressure levels.

There are rare risks specific to VP shunting that can be serious and potentially life-threatening if left
untreated, including:

infection in the shunt or brain

blood clots

bleeding in the brain

damage to brain tissue

swelling of the brain

Fever, headache, abdominal pain, fatigue, and a spike in blood pressure levels, or having the same
symptoms that were present when the shunt was initially placed, can indicate an infection or a
malfunction of the shunt. Notify your doctor immediately if these signs and symptoms develop.
According to the University of Chicago, infection is most common in the first few weeks after a shunt
placement.

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Outlook

Shunting is successful in reducing pressure in the brain in most people. VP shunts are likely to require
replacement after several years, especially in small children. The average lifespan of an infant’s shunt is
two years. Adults and children over the age of 2 may not need a shunt replacement for eight or more
years. Shunt systems require frequent monitoring and follow-up. Complications that may occur with
shunt systems include:

mechanical failure

obstructions

infections

Malfunctions can lead to serious complications, such as over- or under-draining of CSF. Over-draining
occurs when CSF drains from ventricles at a faster rate than it’s produced. This can cause ventricles to
collapse, which may lead to headaches or hemorrhage inside the brain. Under-draining allows CSF to
accumulate on the brain and can cause symptoms of hydrocephalus to return. Seek immediate medical
attention if you experience symptoms that indicate your shunt system isn’t working properly.