VP Shunt Placement & Revision

Cerebrospinal fluid surrounds and protects the brain and spinal cord. It is continuously produced, circulated, and absorbed by the body.

Hydrocephalus occurs when cerebrospinal fluid cannot circulate or be absorbed normally. The excess fluid enlarges the brain’s ventricles and can increase pressure within the skull.

A ventriculoperitoneal shunt is an implanted system that redirects excess cerebrospinal fluid from the brain to the abdominal cavity, where the body absorbs it.

A VP shunt typically includes:

• A ventricular catheter placed within one of the brain’s fluid-filled ventricles
• A valve that helps regulate the flow of cerebrospinal fluid
• A distal catheter that runs beneath the skin and drains fluid into the abdomen

The entire system is placed beneath the skin.

Shunt placement may be recommended when hydrocephalus is causing symptoms, increasing pressure on the brain, or placing neurological function and development at risk.

Hydrocephalus may be associated with:

• Congenital conditions
• Spina bifida
• Premature birth or intraventricular hemorrhage
• Brain tumors
• Infection
• Head trauma
• Bleeding within the brain
• Blockage of normal cerebrospinal fluid pathways

For some patients, Endoscopic Third Ventriculostomy may be an alternative to shunt placement. The appropriate treatment depends on the patient’s age, anatomy, cause of hydrocephalus, and overall health.

VP shunt placement is performed under general anesthesia.

The surgeon makes a small incision in the scalp and creates a small opening in the skull. A catheter is carefully placed within one of the brain’s ventricles.

The shunt valve is positioned beneath the scalp. A second catheter is then tunneled beneath the skin from the head to the abdomen. This allows excess cerebrospinal fluid to drain into the abdominal cavity, where it can be absorbed naturally.

The surgical team confirms that the system is functioning properly before closing the incisions.

Shunt revision is surgery performed to repair, replace, reposition, or remove part or all of an existing shunt system.

A revision may be needed if the shunt becomes blocked, infected, disconnected, damaged, or no longer drains cerebrospinal fluid appropriately.

Depending on the problem, the surgeon may replace only one component or revise the entire shunt system.

Why Might a Shunt Need Revision?

A shunt may require revision because of:

• Blockage within the ventricular catheter, valve, or distal catheter
• Infection
• Mechanical failure
• Disconnection or breakage
• Movement of a catheter
• Over-drainage or under-drainage
• Changes related to a child’s growth
• A change in the patient’s hydrocephalus or anatomy

The need for revision does not necessarily mean that the original surgery was unsuccessful. Shunts are mechanical devices, and some patients require one or more revisions over time.

Symptoms of a shunt infection may include:

• Fever
• Redness, swelling, or tenderness along the shunt pathway
• Drainage from an incision
• Headache
• Vomiting
• Irritability
• Excessive sleepiness
• Abdominal pain
• Return of hydrocephalus symptoms

Families should contact the treating medical team promptly if they are concerned about infection.

Most children and adults with a VP shunt go on to live active, healthy lives. Once hydrocephalus is effectively treated, many patients return to school, work, sports, and their usual daily activities. The shunt itself is entirely beneath the skin and is not visible except for a small area beneath the scalp where the valve is located.

Although a VP shunt is designed to provide long-term treatment, it requires ongoing monitoring throughout life. Patients and families should become familiar with the signs of shunt malfunction or infection and seek prompt medical attention if new symptoms develop.

Everyday Life With a VP Shunt

• School and work: Most patients return to school or work once they have recovered from surgery and their neurosurgeon has cleared them to resume normal activities.
• Sports and recreation: Many children and adults can participate in sports and recreational activities. Your neurosurgeon can advise whether any restrictions are appropriate based on your condition and the type of activity.
• Travel: Traveling with a VP shunt is generally safe. It is helpful to carry information about your shunt, including the type of valve and the name of your treating neurosurgeon, especially when traveling long distances.
• MRI scans: Many modern shunts are MRI compatible, but some programmable shunt valves may need to be checked or reprogrammed after an MRI. Always inform your healthcare providers that you have a VP shunt before undergoing imaging.
• Regular follow-up: Even when you feel well, routine follow-up visits help ensure the shunt continues to function properly and allow your neurosurgical team to address any concerns before they become more serious.

When to Call Your Doctor

Contact your neurosurgical team promptly if you notice persistent headaches, nausea or vomiting, increasing sleepiness, vision changes, changes in behavior, balance problems, redness or swelling along the shunt, fever, or any symptoms that resemble those experienced before the shunt was placed. Early evaluation can help identify shunt problems before serious complications develop.