Ventriculoperitoneal (VP) Shunt Procedure
What is VP Shunting Procedure?
VP (ventriculoperitoneal) shunting is a surgical procedure for treating a medical condition called hydrocephalus, which occurs due to excessive fluid accumulation in the ventricles of the brain. This fluid is called Cerebrospinal Fluid (CSF) and it is responsible for providing cushion to the brain and protecting from any internal injury to the skull.
When the normal flow of this fluid gets disturbed, it starts getting accumulated and creates pressure on the brain's tissues, leading to serious harm to the brain. This problem can affect anyone of any age.
During the procedure, a device called VP shunt is placed inside the brain ventricles. The device then exudes the additional fluid into the peritoneal cavity where the fluid gets absorbed thereafter.
Fluid accumulation occurs due majorly due to -
- blockage in the brain arteries preventing CSF to flow throughout the brain
- Excessive production of CSF
- Poor absorption of fluid by the blood vessels
Patients commonly feel following symptoms when there is fluid build up:
- Increased head size
- Headache and seizures
- Loss of appetite and excessive sleeping
- Loss of memory and impaired vision
What happens during the procedure?
- The procedure is performed under general anesthesia and takes around one and a half to two hours.
- Before starting the procedure, a particular area of patient's head is shaved and sterilized. The surgeon then makes U shaped incision behind the ear and another small one in the stomach.
- Now with the help of a small hole that is made by drilling in the brain, a catheter is inserted that reaches the ventricle of the brain. These days, it is done mostly through endoscope that lets the surgeon see the internal area of ventricle.
- A second catheter is then placed under the skin at the back the ear . It is then passed down through the neck and chest till the stomach area.
- Now a fluid pump (or valve) is put below the skin behind the ear. This valve is then connected with both the catheters .
- As soon as there is extra pressure in the brain due to fluid buildup, the valve and lets excessive fluid get drained in the peritoneal cavity of the stomach through the catheter. Thus helping in lowering the intracranial pressure.
- After the completion of this procedure, patient is shifted to recovery room for observation and then to the ward area from where he/she gets discharged.
Patients are asked to lie flat for initial 24 hours after the procedure and then with the help of medical attendant they are made to sit. Depending upon the condition and speed of recovery, he or she may get discharged in 3 to 4 days.
Medical and nursing team are there for close monitoring and they give antibiotics, pain killers and IV fluid during the post op stay in the hospital.
At the time of discharge, patient and attendant is given special instructions regarding taking care of shunt at home and preventing it from infection.
Risks involved in VP Shunting Procedure
Common risks associated with this procedure include -
- Bleeding and infection at the surgical site
- Infection of the shunt
- Blood clotting
- Internal bleeding in the brain
- Damage to brain tissues during procedure
- Swelling in the brain
Though these complications are rare but need to be avoided with the expert advice of the surgical team and regular follow up.
The treating doctor needs to be contacted immediately in case of following symptoms:
- Pain in the stomach or incision site of brain and stomach
- High fever
- Increased blood pressure
Malfunction of VP Shunt
Please note that VP shunt can malfunction or get clogged over a period of time. And if the shunt doesn't work properly, it would be unable to drain the excess fluid out of brain and thus lead to increased pressure on the brain again.
Therefore, it is essential to understand what are the indicative signs and symptoms of shunt malfunctioning:
- Headache that would aggravate and keep getting worse with time
- Feeling dizzy and sleepy all the time
- Sudden onset of vomiting
- Vision impairment
- Swelling and pain in the skin area through which shunt has been placed
- Urinary incontinence
- Return of symptoms that existed before the VP shunting procedure
In all the above cases, treating doctor needs to immediately informed. He will examine the patient and get some investigations done to decide further treatment line in such a situation.
In case of children, the shunt will require to be changed time and again. With the growing age and body, child will need longer shunt.
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