Name of the Procedure:

Creation of Shunt; Ventriculo-Peritoneal, -Pleural, Other Terminus (VP Shunt, Ventriculopleural Shunt)

Summary

A ventriculo-peritoneal shunt (VP shunt) is a surgical procedure performed to relieve pressure on the brain caused by fluid accumulation. It involves placing a small tube (shunt) that redirects excess cerebrospinal fluid (CSF) from the brain's ventricles to another part of the body, such as the peritoneal cavity in the abdomen or the pleural cavity in the chest.

Purpose

The procedure addresses conditions that cause an abnormal build-up of cerebrospinal fluid in the brain, such as hydrocephalus. The goal is to alleviate symptoms related to increased intracranial pressure and prevent further damage to brain tissues.

Indications

• Hydrocephalus (congenital or acquired)
• Normal pressure hydrocephalus (NPH)
• Pseudotumor cerebri (Idiopathic Intracranial Hypertension)
• Symptoms like headaches, nausea, vomiting, balance issues, and cognitive difficulties
• Enlarged ventricles observed in imaging studies

Preparation

• Fasting after midnight on the day of the surgery
• Adjustments or discontinuation of certain medications as advised by the healthcare provider
• Preoperative assessments such as MRI or CT scans to evaluate brain structures

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made on the scalp.
3. A burr hole is drilled into the skull to access the ventricles of the brain.
4. The shunt's proximal catheter is inserted into one of the brain’s ventricles.
5. The distal end of the shunt is tunneled under the skin and positioned in the peritoneal or pleural cavity.
6. Incisions are closed and the shunt system is tested to ensure proper function.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Neurosurgeon
• Surgical nurse
• Anesthesiologist
• Surgical technologist

Risks and Complications

• Infection
• Shunt malfunction or blockage
• Bleeding
• Damage to brain tissues
• Abdominal or pleural complications
• Seizures
• Overdrainage or underdrainage of CSF

Benefits

• Relief from symptoms related to increased intracranial pressure
• Improved quality of life
• Prevention of further brain damage

Recovery

• Hospital stay of a few days for monitoring
• Pain management with prescribed medications
• Instructions on incision care
• Guidelines on resuming daily activities
• Follow-up appointments to monitor shunt function

Alternatives

• Endoscopic third ventriculostomy (ETV)
• Medical management with medications
• Frequent lumbar punctures (in select cases)

Patient Experience

During the procedure, the patient is under anesthesia and will not feel pain. Afterward, there may be some discomfort and pain at the incision sites, managed with pain relief medications. The patient might experience immediate symptom relief from reduced intracranial pressure but should follow all postoperative care instructions and watch for signs of complications.