Understanding VP Shunt Placement

What is VP shunting?

Within our bodies is an important clear liquid that surrounds the brain and spinal cord. Called cerebrospinal fluid, this liquid cushions the brain inside the skull. It also delivers nutrients to, and removes wastes from, the brain.

Normally, our bodies produce just the right amount of new cerebrospinal fluid each day (the old fluid is constantly reabsorbed into our bloodstream). However, due to birth defects, injury or illness, cerebrospinal fluid can sometimes build up inside the brain.

The excess fluid places dangerous pressure on the brain's tissues — a condition known as hydrocephalus. If left untreated, hydrocephalus can cause serious symptoms and eventual brain damage.

Hydrocephalus is often treated with a surgical procedure called ventriculoperitoneal (VP) shunting.

During the procedure, a neurosurgeon places a device called a VP shunt (also known as a brain shunt or cerebral shunt) inside the brain. The shunt is comprised of several thin, hollow tubes called catheters that run from your brain to another part of your body (usually the chest or abdomen). Once in place, the shunt drains the excess cerebrospinal fluid from the brain and carries it to the chest or abdominal cavity, where it is reabsorbed.

Preparing for your VP shunt placement

First, your neurosurgeon will confirm whether you are healthy enough for surgery. He will perform a thorough medical examination, review your medical history and, if necessary based on your current health status, order additional tests.

If you are approved for surgery, you will need to complete a consent form giving your Lyerly physician permission to perform the procedure. Please read the form carefully, and make sure to let your doctor know if you have questions or concerns.

The following general guidelines apply to most people who are scheduled for VP shunt placement. Your doctor or another clinician from Lyerly Neurosurgery may give you additional instructions.

• If you are a smoker, you must not smoke for at least seven days prior to your surgery. This will help reduce your risk of complications. Please let your doctor know if you need help with smoking cessation.
• The night before your surgery, you should not eat or drink anything after midnight.
• The morning of your surgery, do not take any prescription or over-the-counter medications that can increase bleeding risk. These include blood thinners and nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen and naproxen).
• If you use other daily prescription medications, you may be able to take them as usual the morning of your surgery — your doctor will let you know what is safe to use.
• Unless instructed otherwise, your surgery will take place at Baptist Medical Center Jacksonville. Please check in at the registration area located on the first floor of the J. Wayne and Delores Barr Weaver Tower. You will be given detailed instructions on what time to arrive and where to park.
• Bring your prescription or over-the-counter medications with you to the hospital, in their original containers.
• Don't forget to notify our team if you have a history of bleeding disorders, or if you are allergic (or have a sensitivity) to any medications, anesthesia, latex or adhesive tape.

What to expect during your surgery

On average, VP shunting takes 90 minutes to complete.

This procedure is performed under general anesthesia, meaning you will be asleep during surgery.

A member of your surgical team will shave hair from the area behind one of your ears. Once this area is shaved, your neurosurgeon will make a small incision behind the ear, then drill a tiny hole in your skull.

Next, your surgeon will place two catheters in your body. He will insert one catheter into your brain through the hole in your skull, and place the second catheter underneath the skin behind your ear (where the incision was made).

The second catheter will run down through your neck and end in your chest or abdomen. Your surgeon may need to make a small incision in your chest or abdomen to make sure the end of the catheter is positioned correctly.

When the two catheters are in place, your surgeon will connect them with a valve that acts as a fluid pump. The valve will also be placed underneath your skin, behind your ear. Moving forward, when excess cerebrospinal fluid collects in your brain, the valve will open and the fluid will drain through the catheter.

Once your VP shunt is in place and your incisions have been stitched closed, you will be taken to a recovery area for observation.

What to expect after your surgery

The average length of stay in the hospital following VP shunt placement is two to four days.

Immediately after surgery, you will be monitored closely by your doctor and his health care team. First you'll be taken to a recovery area for short term observation, and then you will be transferred to an inpatient room for continued surveillance.

Before you are discharged from the hospital, members of your health care team will make sure your new shunt is working properly. They also will help guide you through your transition to home. For example, they will make sure you understand what medications to take, and when you may resume bathing, driving and physical activity.

Your doctor or another member of the Lyerly Neurosurgery team will give you detailed instructions for taking care of yourself once you're home. However, the following general guidelines apply to most people:

• It is normal to have pain and discomfort around your incisions for several days. During this time you should avoid heavy lifting and other strenuous activities. Your doctor will talk to you about pain medications that are safe to use.
• Make sure to keep your incisions clean and dry.

While you are recovering at home, pay attention to any unusual symptoms. Call our office at 904.861.0316 if you experience any of the following:

• redness, swelling, bleeding or drainage from your incisions
• skin redness, tenderness, pain or swelling along the length of the catheter
• pain that gets worse over time, or cannot be managed with pain medication
• headache
• fever
• abdominal pain
• excessive fatigue

Are there any risks I should be aware of?

As with any surgical procedure, VP shunting is associated with rare but serious risks. These include:

• an allergic reaction to the anesthesia
• an infection at the site of your incision
• an infection along the shunt
• blood clots (which can become lodged in a blood vessel and cause a stroke)
• bleeding in the brain
• brain swelling

In addition to risks from the surgery itself, there are separate risks associated with having a VP shunt system in your body. Complications directly related to the shunt include:

• mechanical failure (for example, the valve stops working properly)
• obstructions, such as a clog in the valve or one of the catheters
• infection

If your shunt stops working properly, it can cause the cerebrospinal fluid to drain from your brain too quickly or too slowly. In either case, serious symptoms can occur and you may need additional surgery.

If you have any questions or concerns about the safety of this procedure, please do not hesitate to discuss them with your doctor.

How long will the VP shunt remain in my body?

Because hydrocephalus is a chronic disorder with no cure, most people with this condition will need their shunt system for the rest of their lives.

Shunts need to be replaced over time due to normal "wear and tear." While infants and young children may need their shunts replaced every two years, the average adult will need their shunt replaced every eight years.

Due to the risk of complications associated with VP shunts, you will need to see your doctor regularly for monitoring.

The region's trusted brain surgery experts

We understand how important it is for you to have confidence in your neurosurgeon.

Since Lyerly Neurosurgery was founded in 1934, our physicians have cared for thousands of people who need treatment for a brain or spine condition.

Today our practice continues to build upon a legacy that blends compassion, safety and innovation. Our neurosurgeons provide the full spectrum of evidence-based care, including the latest minimally invasive procedures that can only be offered by neurosurgeons with advanced training and experience.

If you or a loved one needs VP shunting, you'll find the care and support you need at Lyerly Neurosurgery. In partnership with Baptist Medical Center Jacksonville, our team provides emergency and preventive surgical treatment for most neurological conditions including hydrocephalus.