About Your Surgery
This information will help you prepare for your surgery to have your programmable or nonprogrammable ventriculoperitoneal (VP) shunt placed at Memorial Sloan Kettering (MSK), and help you understand what to expect during your recovery. Read through this guide at least once before your surgery and then use it as a reference in the days leading up to your surgery. Bring this guide with you every time you come to MSK, including the day of your surgery, so that you and your healthcare team can refer to it throughout your care.
A VP shunt is used to drain extra fluid that circulates around the brain and spinal cord. This fluid is called cerebrospinal fluid (CSF). It is found in the ventricles of the brain and the spinal canal. If too much CSF is in the ventricles, it puts pressure on the brain and skull. This is called hydrocephalus (see Figure 1).
Figure 1: Brain without and with hydrocephalus
The most common symptoms of hydrocephalus include:
- Fatigue and/or drowsiness
- Nausea and vomiting
- Problems with thinking and memory (e.g., confusion)
- Trouble with balance and walking
- Loss of control over urination
To help drain the extra CSF from the brain, a VP shunt is inserted into the head. The shunt takes the fluid out of the brain and moves it into the abdomen, where it is absorbed by the body. This decreases the pressure and swelling in the brain.
A VP shunt has 3 parts (see Figure 2):
- A one-way valve with reservoir
- A short catheter (thin, flexible tube)
- A long catheter
The valve controls the flow of fluid. It is attached to the short catheter to drain the fluid away from your brain. The short catheter can be placed in the front, back, or side of your head. The long catheter is also attached to the valve. It is then tunneled under your skin, behind your ear, down your neck, and into your abdomen.
As the VP shunt drains excess CSF and decreases the pressure in your brain, it may relieve your symptoms. Some symptoms will disappear immediately after the VP shunt is inserted. Others will go away more slowly, sometimes over a few weeks.
The amount of fluid that is drained by your VP shunt depends on the settings on the shunt. With a nonprogrammable VP shunt, the settings are made in advance by your doctor and cannot be changed. With a programmable VP shunt, the settings can be changed by your doctor.
Your neurosurgeon will decide which type of VP shunt is best for you.
VP Shunt Surgery
The surgery to place your VP shunt is done in the operating room while you are asleep. Once you are asleep, the hair along your incision line will be shaved. Your entire head will not be shaved.
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 correctly. The incisions will be closed with stitches or staples.
You will not be able to see the catheter because it will be under your skin. However, you may be able to feel the shunt tubing along your neck.
Once all the parts of the shunt are connected, it will start draining the excess CSF as needed to reduce the pressure in your brain.
The surgery will take about 1 hour.Back to top
Before Your Surgery
The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
You and your healthcare team will work together to prepare for your surgery.
About Drinking Alcohol
The amount of alcohol you drink can affect you during and after your surgery. It is important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.
- Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you are at risk for these complications, we can prescribe medications to help prevent them.
- If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, greater dependence on nursing care, and longer hospital stay.
Here are things you can do to prevent problems before your surgery:
- Be honest with your healthcare provider about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or cannot sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you cannot stop drinking.
- Ask us any questions you have about drinking and surgery. As always, all of your treatment information will be kept confidential.
Help us keep you safe during your surgery by telling us if any of the following statements apply to you.
- I take a blood thinner. Some examples are aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), tinzaparin (Innohep®), and enoxaparin (Lovenox®). There are others, so be sure your doctor knows all the medications you’re taking.
- I take prescription medications, including patches and creams.
- I take any over-the-counter medications, herbs, vitamins, minerals, or natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
- I have sleep apnea.
- I have had a problem with anesthesia in the past.
- I have allergies, including to latex.
- I am not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke.
- I use recreational drugs.
People who smoke can have breathing problems when they have surgery. Stopping even for a few days before surgery can help. If you want to quit, call our Tobacco Treatment Program at 212-610-0507. You can also ask your nurse about the program.
About Sleep Apnea
Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). This means that the airway becomes completely blocked during sleep, so no air can get through. OSA can cause serious problems when you have surgery. Please tell us if you have sleep apnea or if you think you may have it. If you use a breathing machine (such as a CPAP) for sleep apnea, bring it with you the day of your surgery.
Before your surgery, you will be given an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.
During your PST appointment, you will meet with a nurse practitioner who works closely with anesthesiology staff (doctors and specialized nurses who give you medication to sleep during surgery). You can eat and take your usual medications the day of your PST appointment.
During your appointment, your nurse practitioner will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your nurse practitioner may also recommend you see other healthcare providers.
Your nurse practitioner will talk with you about which medications you should take the morning of your surgery. To help you remember, we’ve left space for you to write these medications down in “The Morning of Your Surgery” section of this guide. It is very helpful if you bring the following with you to your PST appointment:
- A list of all the medications you are taking, including patches and creams.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram (echo), or carotid doppler study.
- The name(s) and telephone number(s) of your doctor(s).
Health Care Proxy
If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you are unable to communicate for yourself. The person you identify is called your health care agent. If you are interested in completing a Health Care Proxy form, or to learn more, talk with your nurse. If you have completed one already, or if you have any other advanced directive, bring it with you to your next appointment.
Tell Us if You’re Sick
If you develop any illness before your surgery, call the doctor who scheduled your surgery. This includes a fever, cold, sore throat, or the flu.
Stop taking aspirin, medications that contain aspirin, and vitamin E. These medications can cause bleeding. If you take aspirin because you’ve had a problem with your heart, be sure to talk with your doctor if you haven’t already. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs) located in the Additional Resources section.
Stop Taking Herbal Remedies and Supplements
For more information, please read Herbal Remedies and Cancer Treatment located in the Additional Resources section.
Watch a Virtual Tour
This video will give you an idea of what to expect when you come to Memorial Sloan Kettering’s main hospital on the day of your surgery.
Stop Taking Certain Medications
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Advil®, Motrin®) and naproxen (e.g., Aleve®). These medications can cause bleeding. For more information, please read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs) located in the Additional Resources section.
Note the Time of Your Surgery
A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. He or she will tell you what time you should arrive at the hospital for your surgery. If you are scheduled for surgery on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm the evening before your surgery, please call 212-639-5014.
On the day of your surgery, go to the main hospital at 1275 York Avenue between East 67th and East 68th Streets. Take the B elevator to the 6th Floor to the Presurgical Center (PSC).
Unless you are given other instructions, you can shower and wash your hair. Do not apply any hair products such as hair spray or hair gel.
Go to bed early and get a full night’s sleep.
Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of clear liquids (see Figure 3).
Examples of clear liquids include:
- Clear broth, bouillon, or consommé (no particles of dried food or seasonings)
- Gelatin, such as Jell-O®
- Clear fruit juices (no pulp), such as white cranberry, white grape, or apple
- Soda, such as 7-Up®, Sprite®, ginger ale, seltzer, or Gatorade®
- Coffee or tea, without milk or cream
Take Your Medications
If your doctor or nurse practitioner instructed you to take certain medications the morning of your surgery, take only those medications with a small sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.
Things to Remember
- Wear loose-fitting clothing.
- Do not put on any lotion, cream, deodorant, makeup, powder, or perfume.
- Do not wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Leave valuables, such as credit cards, jewelry, or your checkbook, at home.
- Before you are taken into the operating room, you will need to remove your eyeglasses, hearing aids, dentures, prosthetic device(s), wig, and religious articles, such as a rosary.
- If you wear contact lenses, wear your glasses instead.
What to Bring
- A CD player and CDs or an iPod, if you choose. However, someone will need to hold these items for you when you go into surgery.
- Only the money you may need for a newspaper, bus, taxi, or parking.
- Your breathing machine for sleep apnea (such as your CPAP), if you have one.
- A case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles such as a rosary.
- Your Health Care Proxy form, if you have completed one.
- This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
Parking When You ArriveParking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right hand (north) side of the street. There is a pedestrian tunnel that connects the garage to the hospital. If you have questions about prices, call 212-639-2338.
There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Once You’re in the Hospital
You will be asked to state and spell your name and date of birth many times. This is for your safety. People with the same or similar name may be having surgery on the same day
Get Dressed for Surgery
You will be given a hospital gown, robe, and nonskid socks.
Meet With Your Nurse
Your nurse will meet with you before your surgery. Tell him or her the dose of any medications (including patches and creams) you took after midnight and the time you took them.
Meet With Your Anesthesiologist
He or she will:
- Review your medical history with you.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia (medication to make you sleep) you will receive.
- Answer any questions you may have about your anesthesia.
Prepare for Surgery
Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to begin. When it is time for your surgery, your visitor(s) will be shown to the waiting area. Your visitors should read Information for Family and Friends for the Day of Surgery located in the Additional Resources section.
During your surgery, you will receive medication through your IV, MediPort, or central venous catheter (CVC). The medication may make you feel drowsy and will control your pain.
You will be brought into the operating room. Once you are asleep, your surgery will begin. You will not feel any pain during your surgery.Back to top
After Your Surgery
The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.
When you wake up after your surgery, you will be in the Post Anesthesia Recovery Unit (PACU). You may have a special mask over your face with air coming out, which will help you wake up after surgery. You will be attached to machines that will monitor your vital signs (body temperature, heart rate, blood pressure, and oxygen level). It is normal to feel very tired after surgery. Your PACU nurse will make sure you are comfortable and answer any of your questions. As soon as you are settled in the PACU, a nurse will bring your family members in to be with you.
Once your anesthesia has worn off, you will be taken to your hospital room. Your nurse will help you sit up in a chair. You and your healthcare team will decide how active you can be based on how you well you are feeling and what is safe for you.
You will have dressings over your incisions. Your doctor will take them off 24 to 48 hours after your surgery and they will be left uncovered.
For the first few days after your surgery, your nurses will:
- 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.
This is to make sure your brain is functioning well.
You may have a computed tomography (CT) scan of your head 1 to 2 days after your surgery. This is to confirm that the catheter is in place.
Commonly Asked Questions
Will I have pain after my surgery?
You may have a mild headache or feel discomfort from your incision lines for the first few days after your surgery. Your nurse will give you pain medication. Please tell your nurse if the medication is not helping your pain.
How long will I be in the hospital?
Unless your doctor decides that you need more tests or treatment, you will go home within 3 to 5 days after your surgery.
When will I be able to eat and drink?
You will be given ice chips to eat after your surgery. You will start with a liquid diet and then progress to solid food.
When will my stitches or staples be removed?
The stitches or staples on your incisions will be removed 7 to 10 days after your surgery. Your doctor or nurse will remove them during your follow-up visit at the clinic.
How do I care for my incisions?
- Check your incisions daily for any signs of infection, including redness, swelling, or drainage.
- Keep your incisions clean and dry for 5 days after your surgery. Do not shower for 5 days after your surgery.
When can I shower?
- You can shower 5 days after your surgery. When you wash your hair, use a gentle shampoo, such as baby shampoo.
- Do not let your incisions soak in water. Avoid baths, hot tubs, and swimming pools until your doctor gives you other instructions.
- Do not use a hair dryer, creams, ointment, or hair products on your incisions until they are completely healed. This takes about 6 weeks.
When can I go back to work?
Your doctor will tell you when you can go back to work.
When can I go back to doing my normal activities?
You can go back to doing your normal activities as long as your doctor approves. If you plan to exercise, ask your doctor if it is safe.
What follow-up care will I receive?
Your first clinic visit will be 7 to 10 days after your surgery. Please call your surgeon’s office to schedule the appointment.
You will have regular visits with your neurologist, neurosurgeon, or both. They will monitor the function of your VP shunt over time.
When can I travel?
Do not travel on an airplane until your doctor says it is okay.
What precautions do I need to take if I have a programmable VP shunt?
The pressure setting of some programmable VP shunts may accidently change if you come too close to a magnet. This depends on the model.
Ask your neurosurgeon if you need to take precautions when coming into contact with magnets. Be sure to follow the manufacturer’s guidelines for magnetic field precautions specific for your type of shunt.
Here are some general rules for many shunts:
- Keep all products with magnets at least 2 inches away from the valve implant site.
- Do not use magnetic therapy pads and pillows.
- Do not use the iPad 2 if you have a Medtronic Strata® programmable VP shunt.
- Do not use audio headsets without checking the shunt manufacturer’s guidelines.
Magnetic resonance imaging (MRI)
If you are having magnetic resonance imaging (MRI), you must tell your MRI technologist that you have a programmable VP shunt before you have the procedure. Your technologist will need to know the model of your shunt and the setting. Your nurse will give you a wallet card with this information. Carry it with you at all times. You can show your technologist the wallet card.
Depending on the model of your programmable VP shunt, the magnet in the MRI scanner may change your shunt’s pressure setting. After your MRI, the pressure setting will need to be checked and/or reprogrammed by your neurosurgeon or nurse. You may need to have x-rays to help determine if the pressure setting has changed.
Before you have your MRI, you must make arrangements with your neurosurgeon or nurse to have it reprogrammed after your MRI. Your shunt should be reprogrammed within 4 hours after your MRI.
Some types of programmable VP shunts are not affected by MRI. Ask your neurosurgeon or nurse if your shunt will need to be reprogrammed after an MRI.
You do not need to take any precautions if you are having a computed tomography (CT) scan or x-ray.
You should always wear a MedicAlert® bracelet or necklace stating that you have hydrocephalus with a programmable VP shunt. If you are ever seriously ill or hurt and need medical help, these items will inform emergency services workers about your VP shunt. You can purchase this type of bracelet or necklace at most drug stores. For more information, visit the MedicAlert® website at: www.medicalert.com
If you ever need to have abdominal surgery, you must tell your neurosurgeon so that precautions can be taken. Tell your neurosurgeon if you have peritonitis or diverticulitis requiring emergency surgery or antibiotic treatment.
When should I call my doctor or nurse?
Call your doctor or nurse if you are having any of the following signs and symptoms that your VP shunt is not working properly:
- Vomiting with little or no nausea
- A constant, unrelieved headache
- Vision problems (blurry vision, double vision, or loss of vision)
- Loss of coordination or balance
- Swelling, redness, or both, along the shunt path
- Difficulty waking up or staying awake
Call your doctor or nurse if you are having signs and symptoms of a VP shunt infection. A VP shunt infection develops when bacteria infect the tissue around a VP shunt. When the tissue is infected, it can cause the VP shunt to stop working properly and increase pressure in the brain. The signs and symptoms of a VP shunt infection include:
- A temperature of 100.4° F (38° C) or higher
- Redness, swelling, or both, of the skin that runs along the shunt path
- Pain around the shunt or around the shunt tubing from the head to the abdomen
These warning signs can appear quickly. If any of these symptoms develop, call your doctor or nurse immediately.
What if I have other questions?
If you have any questions or concerns, please talk with your doctor or nurse. You can reach them Monday through Friday from 9:00 am to 5:00 pm.
After 5:00 pm, during the weekend, and on holidays, please call 212-639-2000 and ask for the doctor on call for your doctor.Back to top
This section contains a list of MSKCC support services, as well as the resources that were referred to throughout this guide. These resources will help you prepare for your surgery and recover safely. Write down any questions you have and be sure to ask your doctor or nurse.
Call to discuss private room or luxury suite options. If you want to change your room choice after your presurgical testing visit, call 212-639-7873 or 212-639-7874.
Call with questions about anesthesia.
Call for more information if you are interested in donating blood or platelets.
MSK welcomes patients from around the world. If you are an international patient, call for help.
At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital, and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.
Many people find counseling helpful. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed.
Integrative Medicine Service offers patients many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.
Learn techniques to help you feel better about your appearance by taking a workshop or visiting the program online at www.lookgoodfeelbetter.org.
You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, we are able to offer you a chance to speak with former patients and caregivers.
Call Patient Billing with any questions about preauthorization from your insurance company. This is also called preapproval.
Call if you have any questions about the Health Care Proxy form or if you have any concerns about your care.
Call if you have any questions about MSK releasing any information while you are having surgery.
Patients may request private nurses or companions. Call for more information.
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also refer you to community agencies and programs, as well as financial resources if you’re eligible.
If you want to quit smoking MSK has specialists who can help. Call for more information.
For additional online information, visit LIBGUIDES on MSK’s library website at http://library.mskcc.org. You can also contact the library reference staff at 212-639-7439 for help.
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who are unable to take the public bus or subway.
Provides travel to treatment centers.
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.
A comprehensive resource for education, tools, and events for employees with cancer.
275 Seventh Avenue (between West 25th & West 26th Streets) New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.
Provides support and education to people affected by cancer.
Provides education and support for those who care for loved ones with a chronic illness or disability.
Free travel to treatment across the country using empty seats on corporate jets.
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that is part of the Good Days formulary.
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.
Provides a list of places to stay near treatment centers for people with cancer and their families.
Provides support and advocacy for the LGBT community, including a online support groups and a database of
LGBT friendly clinical trials.
Free cancer legal advocacy program.
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.
Lists Patient Assistance Programs for brand and generic name medications.
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.
Helps qualifying patients without prescription drug coverage get free or low-cost medications.
Provides assistance with copayments for patients with insurance.
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.
- Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
- Herbal Remedies and Cancer Treatment
- Information for Family and Friends for the Day of Surgery