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What is A Ventriculoperitoneal Shunt?

A Ventriculoperitoneal (VP) Shunt is a hollow tube that is surgically placed in the brain or spine to drain excessive cerebrospinal fluid and reroute it to another part of the body where it can easily be reabsorbed. Shunt procedures can relieve brain pressure caused by hydrocephalus or excessive cerebrospinal fluid and relieve symptoms such as difficulty in walking, lack of bladder control and faint symptoms of dementia.

If a lumbar puncture proves that these problems have improved, it could mean that placing a shunt would provide long-lasting benefits to the patient.

Hydrocephalus occurs when excessive cerebrospinal fluid (CSF) accumulates in the ventricles of the brain. The CSF fluid is very important to us as it performs vital functions such as protecting the brain from injury in the skull, acting as a conduit for the nutrients the brain needs and removing all waste substances. Usually, CSF passes through these ventricles to the bottom of the brain where the brain and spinal cord are completely covered with this fluid before it can be reabsorbed into the blood.

However, at times this normal flow is disrupted. At such times, the fluid collects to alarming proportions which can create a lot of pressure on the tissues in the brain while damaging the organ too. To correct such a condition, doctors surgically place VP shunts in one of the brain's ventricles so that the fluid contained inside it is rerouted away from the brain and normal flow of CSF and its absorption are assured.

When is Ventriculoperitoneal Shunt the best solution?

Hydrocephalus can afflict people of any age, necessitating a VP shunt. However, it is more common among babies rather than adults. Excessive CSF can accumulate around the brain for these reasons:

  • Overproduction of CSF
  • Low CSF absorption by blood vessels
  • Blockages prevent CSF from flowing normally all over the brain

Blockages, cysts, inflammation and tumours usually hamper the normal flow of CSF in the brain and cause a lot of fluid accumulation.

If one suffers from these symptoms of hydrocephalus, a VP shunt should be considered:

  • Large size of head
  • Impaired vision
  • Headaches and seizures
  • Sleeping a lot
  • Irritability
  • Poor appetite
  • Memory loss
  • Slow cognition
  • Incontinence
  • Lack of normal coordination

How do doctors perform this surgery?

The patient is placed under general anaesthesia before doctors can perform this surgery. The patient will lose consciousness during the surgery and will not feel any pain or discomfort. Typically, this procedure takes 90 minutes.

Before having the surgery, patients should ask their doctor about any restrictions on food and drink before the procedure. Adults and older children should be without food for about eight hours before surgery. Babies and toddlers should have their last meal six hours before the procedure, but can drink a little water till four hours before the procedure. All these instructions should be reviewed by your doctor's team.

To prepare a patient for the surgery, the nurse will shave off the area behind the patient's ear as they will place the catheter at this point to drain out excess fluid. The surgeon will make a small cut behind the ear and make a small hole in the skull. Through this opening, they will pass one catheter into the brain. Another catheter will go behind the ear and will remain below the skin. It will go down to the patient's chest and stomach where it will empty some of the CSF in the stomach where it can be easily absorbed.

The surgeon will then link a small pump to each catheter and put it below the skin behind the patient's ear. The pump will help remove all the fluid once the pressure in the skull increases.

 

Complications after a VP Shunt surgery:

There could be certain complications post-VP Shunt surgery, such as bleeding, infection and malfunctions. Malfunctions can go on to be serious conditions such as over- or under-draining of CSF. Over-draining occurs when the liquid from the ventricles is pumped out much faster than it is produced. As a result, the ventricles collapse, causing headaches or brain haemorrhage.

Under-draining, on the other hand, allows the CSF to gather on the brain and can make hydrocephalus symptoms recur. Patients who experience these symptoms should seek immediate medical care.

Other risks of shunt include adverse reactions to anesthesia that include respiratory difficulties, high or low blood pressure levels and altered heart rate. Certain life-threatening risks of VP shunting include blood clots, damage to the brain tissue and swelling of the brain. Fever and abdominal pain are not uncommon at such times.

 

Post-surgery

It takes about three to four days for a patient to recover fully from a VP shunt procedure. Usually, patients leave the hospital within a week of the procedure. A patient's brain shunt recovery time depends on the need for the shunt and the kind inserted.

In hospital, the staff will monitor the patient's heart rate and blood pressure often through the day and the doctor will administer antibiotics. The doctor will ensure that the shunt is in perfect working order before the patient leaves. While in hospital, patients may find some difficulty walking, balance, talking and strength, post-surgery. 

If the doctor feels that the patient is in need of rehab before being discharged, a doctor from this department will examine the former and make certain recommendations about the patient's discharge. To be discharged, the patient should be able to eat, walk and urinate and his surgical wound should show signs of healing well.

 

When to call a doctor:

If after the surgery, you experience these symptoms, call your doctor immediately:

  • Swelling surround the incision
  • If the incision reddens and is wet
  • Respiratory problems or chest pain
  • Fever of 100° temperature or more
  • Blurred or double vision
  • Seizures
  • Vomiting or nausea
  • Severe headaches
  • Change in level of consciousness

Outlook (prognosis):

A shunt procedure successfully reduces brain pressure. However, if hydrocephalus is due to other reasons such as brain tumour, haemorrhage, meningitis or encephalitis, these conditions could further affect the prognosis of a VP shunt. The severity of hydrocephalus before surgery also impacts its outcome.

 

Why KIMS?

Welcome to India's largest and one of the most highly esteemed multi-disciplinary hospitals in Hyderabad. The Krishna Institute of Medical Sciences' Center for Advanced Orthopaedic Surgery (KIMS) has two state-of- the-art centres in Secunderabad and Kondapur. A walk through these hospitals will put any visitor in touch with their ultra-modern facilities, uptodate surgery techniques and recuperative methods by super specialists and experts in Neurosurgery and related areas. Here, a wide range of neurosurgery conditions are examined and treated by widely experienced and highly knowledgeable doctors. So, performing a VP shunt surgery in Hyderabad is very easy, if you come to KIMS.    

Whether your problem is a small surgery or a complicated one, once you put yourself in the hands of our capable specialists, you will be amazed at the extent of surgical and nursing care you receive until you are 100% well. This will give you the confidence that you've come to the right place at the right time and put yourself in the right and most capable hands. No wonder, we often hear our patients say with pride that in being treated at KIMS, they've come to the best Neurosurgery hospitals in Hyderabad, India. Undoubtedly, this makes us very proud.

KIMS aren't just islands of excellence in medical care but also the No. 1 centres in research and development.  In order to consistently give the people of Hyderabad the best medical care and the utmost value for their money, we have on our specialists many neurosurgeons with impressive credentials, each of whom can easily be titled the Best neurosurgeon in Hyderabad India. Such is our commitment to our patients, to always give them the best, come what may.

We hope you and your families will always be well and never need our assistance. But should you ever need to see the top Neurologist in Hyderabad, remember we're only a phone call away. To know more about our Neurology department, connect with us on

http://www.kimshospitals.com/Institutes/institute-of- neuro-sciences/

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