Pressure on the brain resulting from the buildup of excess cerebrospinal fluid (CSF), called hydrocephalus, must be drained, or shunted, to other parts of the body to alleviate pressure and prevent complications. This is usually accomplished with the insertion of a ventriculoperitoneal (VP) shunt, a tube that drains the fluid out. Commonly conducted on children, VP shunt surgery does carry serious risks and these should be discussed with a qualified health care provider prior to scheduling surgery.
Hydrocephalus, or water on the brain, is a condition resulting from the buildup of cerebrospinal fluid inside the skull, resulting in a swelling of the brain. Caused by the improper flow of CSF, individuals with hydrocephalus can potentially lose brain tissue due to the excessive pressure placed on the brain as it is pushed against the inside of the skull. It has been suggested that a condition known as myelomeningocele may be responsible, in part, for the development of hydrocephalus. The spinal column of those with myelomeningocele does not close properly, which leads to the impaired flow of CSF.
Ventriculoperitoneal shunt surgery is conducted under general anesthesia and takes a little over an hour to complete. During the procedure, two incisions are created; one behind the child's ear and the other in his or her abdomen. A small hole is drilled into the skull and an equally small catheter is inserted into the fluid filled cavity, or ventricle, of the brain. A separate catheter is inserted leading to another chamber within the body, usually the abdominal cavity.
Once the catheters are in place, a valve is connected to both and positioned underneath the skin behind the child's ear where the first incision was made. The valve works as a pump, shunting the built up fluid from the child's head to the abdominal cavity. Electronically controlled shunts may be programmed to guide the flow of CSF during the draining process.
Prior to scheduled surgery, the attending physician should be made aware of any medications or supplements the child takes. Pre-operation instructions vary by individual; however, there are certain age-based dietary guidelines which are standard. Up to four hours prior to surgery, children may be given only clear fluids to drink. Six hours prior to surgery is generally the cut off time for eating, so children should not consume any formula, food, or milk after that time.
Children may be hospitalized for up to four days when undergoing surgery for the insertion of a ventriculoperitoneal shunt. Intravenous antibiotics and fluids are administered during recovery, and pain medication may be given when needed. Neurological status and vital signs are closely monitored following the procedure. Prognosis is generally good following a successful procedure, though the severity of hydrocephalus can impact the outcome. Secondary conditions which have presented alongside hydrocephalus, such as encephalitis or a brain tumor, may also influence prognosis.
As with any major surgery, ventriculoperitoneal shunt surgery does carry some risk. Complications associated with any surgical procedure and the use of general anesthesia, such as excessive bleeding, infection, and breathing difficulty, are potential risks associated with this procedure. Risks specifically associated with ventriculoperitoneal shunt surgery include swelling and infection of the brain, damage to the brain tissue, and recurrence of CSF build up in the brain. Additional major complications specific to the shunt procedure include infection and blockage of the shunt.
