What is ventriculoperitoneal shunt surgery?

Ventriculoperitoneal (VP) shunt surgery drains extra fluid out of the brain. The extra fluid moves into the belly and is absorbed by the body. This helps control the pressure in the brain so the brain can work as it should.

Some health problems can cause swelling and pressure in the brain. These include brain tumors and hydrocephalus, which is extra fluid in the brain.

The surgery is done in two parts. First, the doctor drills a small hole in your child's skull. A thin tube is then placed in the brain's fluid-filled part. Then the doctor threads a thin tube from a cut in your child's belly to the chest and neck. The two tubes are then connected with a valve. This allows the fluid to drain into the belly.

Your child will be asleep during the surgery. It usually takes a few hours. But your child will probably need to be in the hospital for several days.

The shunt won't limit your child's activities. There will be a lump on your child's head where the valve is.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Do not touch the valve on your head.
• It is okay for you to lie on the side of your head with the shunt.
• Do not do any activity that may cause you to hit your head.
• You will probably be able to return to work in less than 1 week.
• After your doctor says it is okay to remove the bandages, you can shower. Afterward, be sure to pat the incision areas dry.
• Do not swim or bathe until your stitches or staples are removed.
• Check with your doctor about when it is safe to travel by plane.

Diet

• The tube in your belly will not affect how you digest food. You can eat as usual. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If you have strips of tape on the incisions the doctor made, leave the tape on until it falls off.
• Wash your incision areas daily with warm, soapy water, and gently pat them dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the areas with a gauze bandage if they weep or rub against clothing. Change the bandages every day.
• Keep the areas clean and dry.

The surgery usually takes a few hours. But your child will probably need to be in the hospital for several days.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Ventriculoperitoneal shunts (VP shunts) help control the pressure in the brain. Certain conditions, such as brain tumors or fluid buildup in the brain (hydrocephalus), can cause the brain to swell. When this happens, the brain may not be able to work well. VP shunts help lower the pressure by draining extra fluid out of the brain and into the belly. This extra fluid is absorbed by the body.

After surgery, your child's neck or belly may be tender. But there should not be much pain. You may notice the swelling of your child's head become less right away.

The area around the stitches or staples may be tender for a week or so. If needed, the doctor will remove your child's stitches or staples.

The shunt won't limit your child's activities. There will be a lump on your child's head where the valve is. In some cases, the shunt can't be felt under the skin.

Ventriculoperitoneal shunt surgery (VP shunt surgery) helps control pressure in your brain by draining extra fluid out of your brain and into your belly. During VP shunt surgery, the doctor placed two small tubes (catheters) and a valve under your skin.

After surgery, your neck or belly may feel tender. You will probably feel tired, but you should not have much pain. For a few weeks after surgery, you may have headaches.

It's common to feel some fluid moving around in your scalp. This will go away as your scalp heals. The area around the stitches or staples may feel tender for a week or more. If needed, the doctor will remove your stitches or staples.

The shunt will not limit your activities. There will be a lump on your head where the valve is. You may or may not feel the shunt underneath your skin.

In some cases, your doctor may need to adjust your shunt valve so the right amount of fluid is draining. Watch for signs of infection or signs that the shunt is not working right. If the shunt gets infected or stops working well, it may need to be removed or replaced. Without problems, your shunt may be left in place for years.

• Follow the instructions exactly about when your child should stop eating and drinking. If you don't, the surgery may be canceled. If the doctor told you to have your child take their medicines on the day of surgery, have your child take them with only a sip of water.
• Have your child take a bath or shower before you come in. Do not apply lotion or deodorant.
• Your child may brush their teeth. But tell your child not to swallow any toothpaste or water.
• Do not let your child wear contact lenses. Bring your child's glasses or contact lens case.
• Be sure your child has something that reminds them of home. A special stuffed animal, toy, or blanket may be comforting. For an older child, it might be a book or music.

At the hospital or surgery center

• A parent or legal guardian must accompany your child.
• Your child will be kept comfortable and safe by an anesthesia provider. Your child will be asleep during the surgery.
• The surgery usually takes a few hours.
• After surgery, your child will be taken to the recovery room. As your child wakes up, the recovery room staff will monitor their condition. The doctor will talk to you about the surgery.

To do the surgery, the doctor makes a few small cuts above your ear. These cuts are called incisions. Then the doctor drills a small hole in the side of your skull. The hole lets the doctor put a thin tube into the part of the brain that’s filled with fluid. This tube is called a catheter.

Then the doctor makes another incision in your belly. A second catheter goes into this incision. It is gently pushed under the skin and up to your chest and neck. Next, the doctor uses a valve to attach the two catheters on the side or back of your head. Then the doctor closes up the incisions with stitches or staples. Both catheters and the valve are completely under your skin.