Ventriculoperitoneal Shunt

About Ventriculoperitoneal Shunt

Ventriculoperitoneal shunt placement is one of the most common neurosurgical operations, particularly in children. It treats hydrocephalus, an accumulation of cerebrospinal fluid in the ventricles of the brain, which may result from congenital aqueductal stenosis, spina bifida, bleeding in the brain of premature infants, meningitis, tumors or head injury. The shunt is a system of thin tubes and a one way valve that diverts excess fluid from a ventricle to the peritoneal cavity in the abdomen, where it is absorbed. During the operation a catheter is passed into a ventricle through a small burr hole and connected to a valve beneath the scalp, and a distal catheter is tunneled under the skin of the neck and chest to the abdomen. Valves may have a fixed opening pressure or be programmable, adjustable from outside the head with a magnetic device. Other drainage sites, such as the right atrium of the heart or the pleural space, are used when the abdomen is unsuitable. The main long term problem is shunt malfunction from blockage, breakage, disconnection or migration, which is common over the years and requires revision surgery. Signs of malfunction reflect raised pressure inside the head, such as headache, vomiting and drowsiness. Infection is another significant complication, usually occurring in the first months after surgery. Over drainage can cause headaches or collapse of the ventricles. Endoscopic third ventriculostomy, which creates an opening in the floor of the third ventricle, is an alternative for some forms of obstructive hydrocephalus and avoids implanted hardware.