Ventriculoperitoneal shunt is surgery that is done to relieve pressure inside the skull (intracranial pressure). This pressure is caused by too much cerebrospinal fluid (CSF) on the brain (hydrocephalus). The fluid is drawn off (shunted) from the ventricles in the brain into the abdominal (peritoneal) cavity. In rare cases the fluid is shunted into the pleural space in the chest (the thin covering of the lungs).

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

The child's hair behind the ear is shaved off. An incision or cut in the shape of a horseshoe is made behind the ear. Another small incision is made in your 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.

Another catheter is tunneled under the skin from behind the ear, down the neck and chest, and most of the time into the abdominal cavity. Sometimes this catheter goes to the heart. Sometimes, the doctor makes a small cut in the neck to help thread the catheter.

A valve (fluid pump) is placed underneath the skin behind the ear. The valve is attached to both catheters. When extra pressure builds in the head, fluid is directed to the valve and then drains from inside the head down to the belly or the heart.

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

In hydrocephalus, there is a buildup of fluid of the brain and spinal cord (cerebrospinal fluid or CSF). This buildup of fluid causes pressure on the brain tissue. Too much pressure, or pressure that is present too long, will damage the brain tissue.

A shunt helps to drain the excess fluid and relieve the pressure in the brain. A shunt should be placed as soon as hydrocephalus is diagnosed.

Risks for any anesthesia are:

• Reactions to medications
• Problems breathing

Risks for any surgery are:

• Bleeding
• Infection

Possible risks of ventriculoperitoneal shunt placement are:

• Blood clot or bleeding in the brain
• Brain swelling
• The shunt may stop working and fluid will begin to build up in the brain again
• The shunt may become infected
• Infection in the brain
• Damage to brain tissue

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 fewer 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 usual stay in the hospital is 3 to 4 days.The doctor will check vital signs and neurological status often. Your child may get medication for pain. Intravenous fluids and antibiotics are given. The shunt will be checked to make sure it is working properly.

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.

Etilogical 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.