Ventriculoperitoneal shunt is a surgery performed to relieve pressure inside the skull (intracranial pressure) caused by water on the brain (hydrocephalus). The fluid is drawn off (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 valve (pump) that controls the flow of fluid is attached to the catheter to keep the fluid away from the brain. Another catheter is attached to the pump. It is tunneled under the skin, behind the ear, down the neck and chest, and into the abdominal cavity (peritoneal cavity).

In hydrocephalus, the ventricles of the brain become enlarged with fluid of the brain and spinal cord (cerebrospinal fluid). This condition causes the brain tissue to press (become compressed) against the skull, causing serious nervous system (neurological) problems. Shunting is needed to drain the excess fluid and relieve the pressure in the brain. This should be done as soon as hydrocephalus is diagnosed to give the child the best possible neurological outlook.

In some cases hydrocephalus occurs because of another disease that affects the brain. One example is an intracranial hemorrhage where blood gets into the ventricles of the brain and prevents the fluid from draining properly. In cases like this, a shunt is needed to help remove the fluid and to relieve intracranial pressure.

Risks for any anesthesia are:

• Reactions to medications
• Problems breathing

• Bleeding
• Infection

Other problems include shunt malfunction or blockage, and infection. If the malfunction occurs because the person grows, 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 brain tissue, because the shunt catheter must pass through brain tissue to enter the ventricle. There is a small risk of brain tissue being damaged, resulting in a neurologic deficit.

The outcome for the surgery itself is good. But if hydrocephalus is related to other conditions, such as spina bifida, brain tumor, meningitis, encephalitis, or hemorrhage, these conditions could affect the prognosis. The degree of hydrocephalus before surgery will also affect the outcome.

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

The doctor will closely monitor your vital signs and neurological status. You may get medication for pain. Intravenous fluids and antibiotics are given. You will be checked closely to ensure that the shunt is working properly.

Most people need 2 to 3 days of bedrest in the hospital before they can go home. Often, imaging studies such as CT scans are done after the surgery to confirm that the shunt is in the right place and that the hydrocephalus has gone away.