A ventriculoperitoneal shunt or VP Shunt is a surgical device used by physicians to treat a disease of the brain called hydrocephalus.
Hydrocephalus is a disorder that causes the brain to build up fluid, raising the pressure around the brain. A shunt on the ventriculoperitoneal reduces the pressure. Doctors implant this medical device under general anesthesia.
A ventriculoperitoneal shunt is either programmable or unscheduled. A ventriculoperitoneal shunt has the function of draining excess fluid from a person's brain. Accumulation of fluid can increase brain pressure, which can be harmful. Excess brain fluid is removed by a ventriculoperitoneal shunt, reducing brain pressure to a healthy amount.
Ventriculoperitoneal shunts consist of a valve and two tubes which drain the fluid, termed catheters.
One catheter drains fluid from the brain through a small hole in the skull which the doctor makes. It is known as the inflow catheter. The other, flows under the skin, sending the fluid to a drainage site elsewhere in the body. It is called the Catheter outflow.
The valve, also called pump, controls the shunt so that it drains fluid as needed.
In a non-programmable shunt, the doctor programs the valve so that it activates when the fluid approaches a certain level. After installation, a non-programmable shunt cannot be modified. However, a programmable shunt has an external, customizable valve which can be changed at any time by the doctor according to the needs of the individual.
Doctors sometimes use a ventriculoperitoneal shunt to treat hydrocephalus, also regarded as water in the brain. Hydrocephalus is a disorder in which a person's brain has cerebrospinal fluid (CSF) pooling in the cavities.
CSF supplies the brain with vital foods, and drains waste away. To do this, CSF travels through the brain cavities called ventricles, bathing the brain in the fluid. Hydrocephalus may lead to brain damage or death if left untreated.
When a person has hydrocephalus, it may mean that there is:
-An obstacle that stops CSF draining properly
-Overproduction of CSF
-Improper absorption of cerebrospinal fluid
A person with hydrocephalus may have the following symptoms:
-Loss of bladder or bowel control
-Increased head size
When the patient is under general anesthetic, the doctor suits the shunt.
The doctor will give a person a general anesthetic before they suit the ventriculoperitoneal shunt. Once the person is fully unconscious, the doctor will cut a small hole in their skull through an incision behind their ear.
The doctor then inserts the inflow catheter into the brain. They will fit a valve to the end of the catheter to manage how it works. They feed the outflow catheter below the skin which leads into to a small incision in the abdomen. From here, the body will then reabsorb the drained CSF.
Once the doctor connects all parts of the shunt, the shunt system will begin draining CSF fluid from the brain.
How to prepare
The doctor will advise a person how to get ready for this procedure. The doctor might recommend:
-Stopping alcohol consumption, as this may affect surgery and recovery
-limit vitamin e intake, as it may cause bleeding
-Avoiding herbal remedies and supplements
-Discussing any current medication, as people may need to avoid taking some before surgery
-Discussing any heart devices and results of any screening for heart conditions
-Declaring any allergies
-Talking about how smoking may affect surgery
-Talking about sleep apnea, if present
The doctor can ask a person not to eat after midnight on the night prior to their surgery. They can also advise a person about the quantity of water they should drink before surgery and when to drink it.
Tips for recovery
After the surgical procedure, a person may have a mild headache. The doctor will give them pain medication to manage this.
A person may not be able to eat normally right after surgery. They may need to start with liquids and move on to solid foods.
The doctor will take out a person’s stitches during a follow-up visit. In the meantime, a person should keep their incisions clean and check for any sign of infection daily. Signs of infection may include:
The doctor will inform the person when they can start showering again. It may not be possible to shower straight away, as getting the incisions wet may affect how the wounds heal.
It is a good idea to rest after the surgical procedure to aid recovery. The doctor will recommend when a person can resume normal daily activities and go back to work.
Going under general anesthetic is not dangerous for most people. But some people may have effects like:
-Vaiations in blood pressure
-Changes to heart rate
Occasionally, a ventriculoperitoneal shunt may stop working properly and need replacing. Signs that the device is not working as it should include:
-Redness or swelling where the catheter passes under the skin
-Loss of coordination or balance
-Vomiting without feeling very nauseous
-A headache that will not cease
-Trouble waking up or staying awake
If a ventriculoperitoneal shunt stops working properly, it is likely tthat it may over-drain or underdrain CSF. If the pump drains cerebrospinal fluid faster than the body produces it, a person may experience a brain hemorrhage. If the pump does not drain CSF quickly enough, the symptoms of hydrocephalus might come back.
It is also possible that the ventriculoperitoneal shunt may become infected. Signs of infection include:
-Redness or swelling where the catheter passes beneath the skin
-Pain around the catheter
If a person has any signs of infection, they should see a doctor immediately.
After having a ventriculoperitoneal shunt inserted, a person should not come in contact with magnets. Magnetic fields may affect how the valve on the shunt works.
At times earphones may affect the efficiency of a ventriculoperitoneal shunt, so it is a good idea to check the shunt manufacturer’s guidelines before using them.
If a person needs to have an MRI scan in the future, they should inform the MRI operator that they have a ventriculoperitoneal shunt.
Likewise, if a person has surgery on their abdomen in the future, they should inform the doctor that they have a ventriculoperitoneal shunt.
It is a good idea for someone who has a ventriculoperitoneal shunt to always wear a medical bracelet to alert people in case of an emergency.
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