A ventriculoperitoneal shunt (VPS) also known as cerebral shunt is one the high impact advances made in neurosurgical patient care. Cerebral shunts are used to treat hydrocephalus. If left unchecked, excess cerebrospinal fluid (CSF) can increase intracranial pressure (ICP) resulting in herniation, intracranial hematoma, cerebral edema, or crushed brain tissue. In pediatric patients, untreated hydrocephalus can lead to many adverse effects including increase irritabilities, chronic headaches, learning difficulties, visual disturbances, and in more advanced cases severe mental retardation. 
Shunts consist of a valve housing connected to a catheter, the distal end of which is placed in the peritoneal cavity. The main differences between shunts are the materials used to construct them, the types of valve, and whether the valve is programmable or not. Advances in the biotechnologies are leading to progressive changes in shunt components. These advanced components are expected to reduce shunt malfunctions and optimize neurosurgical patient care.
Placement of cerebral shunt and its location is determined based on the type and location of the blockage causing hydrocephalus. All brain ventricles are candidates for shunting. These include the lateral ventricles, the third ventricle, and the fourth ventricle. The catheter placed in the cerebral ventricle is called the proximal portion of the shunt implying proximity to the brain. The most common proximal shunt location is the right lateral ventricle. The distal (post valve) catheter can be placed in the cardiac atrium via venous, to the chest cavity, bladder, and most commonly placed in the abdomen in peritoneal space. Overall, other locations include the heart and lungs found to be more morbid compared to the abdomen. In all cases, however, the distal end of the catheter can be located in any tissue with epithelial cells capable of absorbing the incoming cerebrospinal fluid (CSF).
A subgaleal shunt is a temporary measure used in infants who are too small or premature to tolerate other shunts. The surgeon forms a pocket beneath the subgaleal space and allows the CSF to drain from the ventricles, creating a fluid-filled swelling on the infant's scalp. As the child grows, these shunts are later converted to a ventriculoperitoneal (VP) or another shunt types.
Conditions that typically requiring shunting include the following:
Absolute contraindications include infection over the entry site. Relative contraindications include coagulopathy and lack of shunt imaging.
A VPS is placed in the operating room by practicing neurological surgeons.
Equipment needed to perform the procedure includes:
Clinician and surgical assistant.
All patients need appropriate preoperative workup and informed consent for surgery and general anesthesia. The patient should be placed supine with the head oriented so that the shunt reservoir lies uppermost. The reservoir is normally located on the right side of the head and feels like a smooth dome under the skin.
See the list below:
Complications include the following:
Ventriculoperitoneal shunts are used to treat hydrocephalus and shunt cerebrospinal fluid from the lateral ventricles into the peritoneum. Tapping a shunt is performed for both diagnostic and therapeutic reasons (e.g., evaluate for infection and relieve blockage).
The ventricles of the brain are a communicating network of cavities located within the brain parenchyma. The ventricular system is composed of two lateral ventricles, the cerebral aqueduct, and the third and fourth ventricle. The choroid plexuses in the ventricles produce CSF, which fills the subarachnoid space and ventricles in a constant cycle of production and reabsorption.
There is no question that VP shunts have saved many lives, but these devices are not without complications. Ultimately, it is the nurse who monitors the patient and has to be aware of the potential complications that can occur. Besides monitoring the patient, the shunt sites have to be monitored for infection, obstruction, and kinks. In addition, the abdomen has to be monitored for peritonitis. Anything unusual has to be reported back to the neurosurgeon immediately. Finally, before the patient is discharged, the family has to be educated on the early identification of shunt failure and how to monitor the child's improvement. In some cases, a home care nurse may be required to pay regular visits to ensure that the VP shunt is functioning without problems. (Level V)
VP shunts can be lifesaving, but the eventual outcome depends on the reason why the shunt was inserted. For benign disorders, most patients have a good outcome. However, for malignant tumors, the outcomes are usually poor; often these patients die from other causes unrelated to the shunt. The complication rates of VP shunts range from 2-20%. In addition, shunt revision is required in about 5-10% of neonates and young children. (Level V)
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