A ventriculoperitoneal (VP) shunt is a narrow plastic tube that drains excess cerebrospinal fluid into your abdomen (belly).
Cerebrospinal fluid (CSF) protects your brain by acting as a shock absorber. It is also a transport system to carry nourishment to the brain and take waste products away from the brain. If there is too much CSF, however, it can put pressure on the brain and cause problems.
What Does a VP Shunt Treat?
A buildup of excess cerebrospinal fluid (CSF) is called hydrocephalus. The extra fluid can build up because the body is either making too much of it or is not draining it properly. The symptoms of hydrocephalous include:
- Nausea and vomiting
- Problems with balance and walking
How Does a VP Shunt Work?
A ventriculoperitoneal shunt has a one-way valve, a device that only allows fluid to move down away from the brain. The valve has a pressure setting. When there is too much cerebrospinal fluid and pressure starts to build, the valve opens and allows CSF to drain until the pressure is restored to the setting chosen by your doctor.
What is the Difference Between Fixed and Programmable Shunts?
Fixed valves have three to five pressure settings. A higher pressure setting typically drains less CSF, and a lower pressure setting usually drains more fluid.
The setting of a fixed valve is chosen before the shunt is placed. It cannot be changed without further surgery. In clinical trials, fixed and programmable valves have worked equally well. The different brands of valves also tend to work about the same in these trials.
Programmable valves, also called adjustable valves, can be adjusted without further surgery. Your doctor can change the pressure setting of this valve during an office visit, using a special magnet. Surgeons tend to choose programmable valves for most shunt placements.
How are VP Shunts Placed?
The operation to place the shunt takes about an hour. You cannot have a visitor with you in the operating room, but a family member or friend can be nearby in a waiting room. Additionally, you will:
- Be given anesthesia, medicine to put you to sleep so you do not feel any pain. A small patch of hair might be shaved.
- The surgeon will make a small cut in your scalp then a small opening in the skull. They will place the tip of the shunt into a ventricle, a fluid-filled space in your brain.
- The surgeon will then make another incision in the abdomen and run the shunt under your skin down into your abdomen. They will close the incisions with stitches or staples and cover these with bandages.
- After the surgery, a nurse will carefully watch you in a recovery room. When you wake up, you will probably feel weak and tired. Your abdomen may be a bit sore. You will soon be able to move to a regular hospital room, where you can rest and recover.
- As you start to feel better, you will be able to get up and walk without help and start to eat solid foods again. You will get to go home as soon as your surgeon feels that you are ready. This is often only a day or two after your surgery.
- At home, you will need to continue to rest. It can take a few weeks before you are strong enough to return to your regular work or school routine.
The shunt itself will not be visible. You may be able to feel the plastic tubing under the skin of your neck, however.
How Do You Care for a VP Shunt?
Your surgeon will provide you with specific care instructions. Generally, there is no day-to-day care needed for a shunt. It is important to attend all follow-up visits with your surgeon. They will check your pressure setting and make sure your shunt is still working properly.
You will probably also need to:
- Tell your surgeon if you ever need abdominal surgery so they can talk with your surgery team about any special precautions.
- Let your surgeon know if you ever had an abdominal infection such as appendicitis or diverticulitis.
- If you have a programmable valve and must have an MRI, set up an appointment to have the pressure setting adjusted on the same day.
If you have a programmable valve, set up an appointment to have the pressure setting checked if you have any of the following symptoms:
- Persistent headaches
- Nausea and vomiting
- More drowsiness than usual
- Slurred speech
- Problems with balance
What are the Risks of VP Shunts?
Shunts are generally safe but can get infected, which is a medical emergency. Your surgeon will give you a list of symptoms of shunt infection and explain what to do if you have those symptoms. It is important to follow their instructions carefully.
Shunts tend to need replacement or adjusting from time to time. This requires another surgery. The signs that the shunt is no longer working properly are usually the same symptoms that you had with hydrocephalus before the shunt was placed. Your surgeon will give you a list of signs that you need to call for an appointment.
What are the Benefits of VP Shunts?
Shunts usually relieve the symptoms of hydrocephalus, often within days of placement. Full recovery can take weeks or months. The shunt will need to remain in place, even after you feel better.
Most importantly, VP shunts treat hydrocephalus well. They relieve the pressure on the brain, reducing the risk of damage from the pressure.