Ventriculoperitoneal shunting is surgery to treat excess cerebrospinal fluid (CSF) in the brain (hydrocephalus).

This article discusses this type of surgery in children.

Shunt - ventriculoperitoneal; VP shunt; Shunt revision

This procedure is done in the operating room under general anesthesia. It takes about 1 1/2 hours.

An area of hair on the child's head is shaved off. This may be behind the ear, or on the top or back of the head.

The surgeon makes a cut in the shape of a horseshoe (U-shape) behind the ear. Another small surgical cut is made in the child's belly.

A small hole is drilled in the skull. A small thin tube called a catheter is passed into a ventricle of the brain. This can be done with or without a computer as a guide. It can also be done with an endoscope that allows to see inside the ventricle.

Another catheter is placed under the skin behind the ear and moved down the neck and chest, and usually into the belly area. Sometimes, it stops at the chest area. The doctor may make a small cut in the neck to help position it.

A valve (fluid pump) is placed underneath the skin behind the ear. The valve is connected to both catheters. When extra pressure builds up around the brain, the valve opens, and excess fluid drains out of it into the belly or chest area. This helps decrease intracranial pressure.

The valves in newer shunts can be programmed to drain more or less fluid from the brain.

This surgery is done when you have too much cerebrospinal fluid (CSF) in the brain and spinal cord. This is called hydrocephalus. It causes higher than normal pressure on the brain. It can cause brain damage.  

Children may be born with hydrocephalus. It can occur with other birth defects of the spinal column or brain.

Shunt surgery should be done as soon as hydrocephalus is diagnosed.

Risks for any anesthesia are:

• Reactions to medications
• Problems breathing
• Changes in blood pressure or breathing rate

Risks for any surgery are:

• Bleeding
• Infection

Possible risks of ventriculoperitoneal shunt placement are:

• Blood clot or bleeding in the brain
• Brain swelling
• Hole in the intestines (bowel perforation), which can occur later after surgery
• Leakage of CSF fluid under the skin
• Infection of the shunt or brain
• Damage to brain tissue
• Seizures

The shunt may stop working. If this happens, fluid will begin to build up in the brain again.

If the procedure is not an emergency (planned surgery):

• Tell your doctor or nurse what drugs, supplements, vitamins, or herbs your child takes.
• Give any drugs the doctor told you to give your child. It is okay if they take them with a small sip of water.
• The doctor or nurse will tell you when to arrive at the hospital.

Ask your doctor or nurse about eating and drinking before the surgery. The general guidelines are:

• Older children should not eat any food or drink any milk for 6 hours before surgery, but they can have clear fluids (juice or water) up until 4 hours before the operation.
• Infants younger than 12 months can usually eat formula, cereal, or baby food until about 6 hours before surgery. They may have clear fluids up until 4 hours before the operation.

Your doctor may ask you to wash your child with a special soap on the morning of the surgery. Rinse well after using this soap.

Your child will need to lie flat for 24 hours the first time a shunt placed. After that your child will be helped to sit up.

The child will probably stay in the hospital for 2-4 days. The health care team will closely monitor your child.  

The child will receive:

• Fluids through a vein
• Antibiotics
• Pain medicines, possibly

Shunt placement is usually successful in reducing pressure in the brain. But if hydrocephalus is related to other conditions, such as spina bifida, brain tumor, meningitis, encephalitis, or hemorrhage, these conditions could affect the prognosis. The severity of hydrocephalus present before surgery will also affect the outcome.

Support groups for families of children with hydrocephalus or spina bifida are available in most areas.

The major complications to watch for are an infected shunt and a blocked shunt.

Etiological categories of neurological disease. In: Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 28.

Kinsman SL, Johnston MV. Congential anomalies of the central nervous system. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 592.

Simon TD, Riva-Cambrin J. Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths. J Neurosurg Pediatrics 1: 131-137 (2008).