Name of the Procedure

Common Name: Ventricular Shunt Procedure
Technical/Medical Term: Ventriculoperitoneal Shunt Placement

Summary

In layman's terms, a ventricular shunt procedure involves placing a medical device in the brain to relieve pressure caused by fluid accumulation. It helps to drain excess cerebrospinal fluid (CSF) from the brain to another part of the body, usually the abdominal cavity, to be absorbed.

Purpose

Medical Conditions Addressed:

• Hydrocephalus
• Brain Tumor Complications
• Increased Intracranial Pressure
• Multisystem Trauma Disruptions

Goals/Expected Outcomes:

• Reduce intracranial pressure
• Alleviate symptoms of hydrocephalus or other conditions causing fluid buildup
• Prevent further neurological damage

Indications

Symptoms/Conditions Warranting the Procedure:

• Persistent headaches
• Nausea and vomiting due to increased intracranial pressure
• Vision problems
• Cognitive or motor impairments
• Patients currently taking antiplatelet medications such as abciximab, anagrelide, cangrelor, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, etc.

Patient Criteria:

• Documented ventricular shunt need
• Diagnosed brain tumor affecting CSF flow
• Multisystem trauma requiring pressure relief
• Patients on specific antiplatelet medications

Preparation

Pre-Procedure Instructions:

• Fasting for 6-8 hours before the procedure
• Discussing current medications with the healthcare provider
• Undergoing pre-operative imaging tests like MRI or CT scans

Diagnostic Tests/Assessments:

• Blood tests to check clotting status, especially if taking antiplatelet medications
• Neurological examination

Procedure Description

Step-by-Step Explanation:

1. Anesthesia: General anesthesia is administered.
2. Incision: A small incision is made in the scalp.
3. Hole Drilling: A burr hole is drilled into the skull.
4. Catheter Insertion: A catheter (tube) is inserted into a ventricle of the brain.
5. Tunneling the Shunt: The catheter is tunneled under the skin to the abdominal cavity.
6. Additional Catheter Placement: A second catheter is placed in the abdomen to absorb the CSF.
7. Connecting Components: The catheters are connected with a valve system that regulates CSF flow.
8. Closure: Incisions are closed with sutures or staples.

Tools/Equipment Used:

• Shunt tubing and valve system
• Surgical scalpels and drills

Anesthesia/Sedation:

• General anesthesia

Duration

Typical Time: 1 to 1.5 hours

Setting

Location:

• Hospital, specifically in an operating room

Personnel

Healthcare Professionals Involved:

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technician

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Shunt malfunction or blockage
• Over-drainage or under-drainage of CSF

Rare Complications:

• Seizures
• Peritonitis (abdominal infection)
• Subdural hematoma

Complication Management:

• Antibiotics for infections
• Surgical revision for shunt malfunction

Benefits

Expected Benefits:

• Relief from symptoms caused by increased intracranial pressure
• Improved neurological function
• Better quality of life

Timeframe for Benefits:

• Symptom relief typically noticed within days to weeks

Recovery

Post-Procedure Care:

• Monitoring in the hospital for 1-2 days
• Regular follow-up appointments

Expected Recovery Time:

• Full recovery in a few weeks

Restrictions/Follow-Up:

• Limited physical activity during initial recovery
• Routine imaging to check shunt function

Alternatives

Other Treatment Options:

• Endoscopic third ventriculostomy (ETV)
• Serial lumbar punctures for temporary relief

Pros and Cons of Alternatives:

• ETV: Less implant-related complications but not suitable for all types of hydrocephalus
• Serial Lumbar Punctures: Temporary and not practical for long-term management

Patient Experience

During the Procedure:

• Under general anesthesia, so no awareness during surgery

After the Procedure:

• Mild to moderate pain managed with medications
• Possible headaches initially
• Some discomfort at incision sites

Pain Management and Comfort Measures:

• Pain medication as needed
• Instructions for incision care and signs of infection to monitor