Ventriculoperitoneal shunt is a surgery performed to relieve intracranial (inside the skull) pressure caused by hydrocephalus (water on the brain). The fluid is shunted from the ventricles of the brain into the abdominal cavity or in rare instances, into the pleural space in the chest.

This procedure is performed in the operating room under general anesthesia. A flap is cut in the scalp and a small hole is drilled in the skull. A small catheter is passed into a ventricle of the brain.

A pump (valve which controls flow of fluid) is attached to the catheter to keep the fluid away from the brain. Another catheter is attached to the pump and tunneled under the skin, behind the ear, down the neck and chest and into the peritoneal cavity (abdominal cavity).

In hydrocephalus, the ventricles of the brain become enlarged with cerebrospinal fluid. This condition causes the brain tissue to become compressed against the skull, thus causing serious neurological problems. Shunting is necessary to drain the excess fluid and relieve the pressure in the brain. This should be done as soon as hydrocephalus is recognized to give the child the best possible neurological outlook.

In some cases hydrocephalus is secondary to another disease process affecting the brain. One example is an intracranial hemorrhage where blood gets into the ventricles of the brain and causes the fluid to not drain properly. In cases like this a shunt is necessary to assist in the fluid being removed to alleviate raised intracranial pressure.

Risks for any anesthesia are:

• reactions to medications
• problems breathing

• bleeding
• infection

Common complications of VP shunt include shunt malfunction or blockage, infection. Malfunction may be related to growth and the shunt will need to be replaced with a longer catheter. Symptoms of shunt malfunction or infection include headache, fever, drowsiness and convulsions.

As with any other brain surgery there is risk to actual brain tissue as the shunt catheter must pass through brain tissue to enter the ventricle. Thus a small but potential risk of brain tissue being damaged and resulting in a neurologic deficit exists.

The outcome from the actual surgery is good. Hydrocephalus is often associated with other conditions such as spina bifida, brain tumor, meningitis, encephalitis or hemorrhage. These conditions would influence the patient's prognosis. The degree of hydrocephalus prior to surgery will also affect the outcome.

Support groups for families of children with hydrocephalus or spina bifida are available in most areas.

The patient's vital signs and neurological status are closely monitored. Medication is given for pain. Intravenous fluids and antibiotics are given. The patient is monitored closely to ensure that the shunt is functioning properly.

Two to three days of bedrest in the hospital are usually required and then the patient may go home. Often, imaging studies such as CT scans are done after the surgery to confirm good positioning of the shunt and resolution of the hydrocephalus.