This information explains your ventriculo-peritoneal shunt surgery and what to expect after.
A ventriculo-peritoneal shunt is often called a V-P shunt for short. It is used to drain extra fluid that circulates around the brain and spinal cord. This fluid is cerebrospinal fluid (CSF), meaning it is fluid found in the ventricles of the brain and the spinal canal. If too much of this fluid is in the ventricles, it puts pressure on the brain and skull (see Figure 1). This is called hydrocephalus.
Hydrocephalus may cause symptoms, depending on what blocks the flow of CSF. Some of the symptoms you may have are:
- Nausea and vomiting
- Problems with thinking and memory; possibly confusion
- Trouble with balance and walking
- Loss of control over urination
As the V-P shunt drains excess CSF and decreases the pressure in the brain, it may relieve your symptoms. Some symptoms will disappear immediately after the V-P shunt is inserted. Others will go away more slowly, sometimes over a few weeks.
The amount of fluid that is drained by the V-P shunt depends on the valve pressure. Most valves are set at a specific pressure and cannot be changed. Other valves can be programmed to a variety of pressures. Your neurosurgeon will decide which type of shunt valve is best for you.
The V-P Shunt
The V-P shunt consists of a one-way valve, a small catheter (a thin, flexible tube), and another longer catheter. The valve controls the flow of fluid. It is attached to the small catheter to drain the fluid away from the brain. The other catheter is also attached to the valve. It is then tunneled under the skin, behind the ear, down the neck and into the abdominal cavity (See Figure 2.) Fluid will drain from the ventricle into the abdomen and will be absorbed into your general circulation. The V-P shunt is designed to last a lifetime. It does not need routine maintenance or replacement.
The procedure is done under general anesthesia in the operating room. Three small incisions will be made, one in your head, one in your neck, and one in your abdomen. These incisions will be used to help guide the catheter so it can be placed accurately. You will not be able to see the catheter because it will be under your skin. You may, however, be able to feel it. The incisions will be closed with stitches or staples. The procedure will take about one hour.
After the Surgery
- After the surgery you will be taken to the Post Anesthesia Care Unit (PACU). Family members can usually visit unless the PACU is too busy. Ask your nurse for the fact card “Visiting Your Family Member or Friend in the PACU.” It explains the guidelines.
- You will be taken to your room once you have recovered from anesthesia.
- When you return to your room, the nursing staff will help you sit up in a chair. You and the staff will decide how active you can be based on how you well you are feeling and what is safe for you.
- You may have a mild headache or feel discomfort from your incision lines for the first few days. Pain medicine will be prescribed for you. Please ask your nurse for it, as you need it.
- Your diet will begin with ice chips after surgery and you will progress from liquids to solid food.
- The stitches or staples on your incision lines will stay in place for about 7 to 10 days. Your doctor or nurse will remove them during your follow-up visit at the clinic.
Your nurses will watch you closely during the first day or two after surgery. They will take your temperature, pulse, blood pressure, and respirations. They will also:
- ask you questions as to where you are and what time of day it is
- ask you to move your arms and legs
- shine a small light into your eyes to check the reaction of your pupils. These are to make sure your brain is functioning well.
You may have a computed tomography (CT) scan of your head one to two days after the surgery. It is to confirm that the catheter is in place.
- Unless your doctor has decided that you need more tests or treatment, you will go home within 3 to 5 days.
- Check your incisions daily. Call your doctor or nurse if you see any signs of infection such as redness, swelling, or discharge.
- Keep your incision lines clean and dry for at least 5 days to help prevent infection. You may shower and wash your scalp with a gentle shampoo or soap after 5 days.
- Do not tub bathe or scrub your incision lines until after your first clinic appointment.
- Your first clinic visit will be 7 to 10 days after the surgery. Please call your surgeon's office to schedule the appointment.
- You may resume your normal activity as long as your doctor approves. If you plan to exercise, ask your doctor if it is safe.
- You may travel on an airplane when your doctor allows it.
- You will have regular visits with your neurologist, neurosurgeon, or both. They will monitor the function of the shunt over time. Your doctor and nurse will discuss this with you.
- Your shunt valve may be “programmable.” That means it can be adjusted to different pressure settings. Carry your patient identification (ID) card at all times. Some programmable shunts must have the pressure setting checked by x-ray anytime you have an MRI. Ask your doctor or nurse to explain if this needs to be done for your model of shunt.
When to Call Your Doctor or Nurse
Call your doctor or nurse immediately if you have:
- Redness, swelling, or discharge at any of the incisions
- A fever of 101º F (38.3º C) or higher
- A constant, unrelieved headache
- A return of your original symptoms
- Any questions or concerns
- Any symptoms you do not expect