A Patient / Family Informed Consent Guide to
Ventricular Peritoneal
(VP) Shunt Insertion /
Revision
Prepared by Department of Neurosurgery
Updated December 2007
Normal Anatomy
The cerebrospinal fluid (CSF) bathes the brain and spinal cord. Most of the CSF
is located in the ventricles of the brain, which are large cavities in the brain that
produce the CSF.
A Patient / Family Informed Consent Guide to
VP Shunt Insertion
In hydrocephalus, the ventricles of the
brain become enlarged with cerebrospinal
fluid. This condition causes the brain
tissue to compress against the skull,
causing serious neurological problems.
Normal CT brain
There are numerous causes for
hydrocephalus depending on the age
group. In adults, common causes
including bleeding inside the ventricles,
infection (eg. meningitis), tumour causing
obstruction, etc. In children, there are
other rarer congenital causes. In the
elderly, a condition called normal
CT brain showing
hydrocephalus pressure hydrocephalus may require a VP
shunt.
Enlarged brain ventricle
A Patient / Family Informed Consent Guide to
VP Shunt Insertion
Procedure
• Shunting, also called
ventriculo-peritoneal
shunting, is necessary in
order to drain the excess
fluid and relieve pressure
in the brain
• A catheter is inserted into
the brain to drain CSF
from the ventricular
system into the
abdominal cavity while
the patient is deep asleep
under general
anaesthesia
A Patient / Family Informed Consent Guide to
VP Shunt Insertion
After the Operation
• The patient’s vital signs and neurological status
are closely monitored. Medication is given for
pain. Intravenous fluids and antibiotics are
given. The patient is monitored closely to ensure
that the shunt is functioning properly
• Often, imaging studies such as CT scans are
done after the surgery to confirm good
positioning of the shunt and resolution of the
hydrocephalus
A Patient / Family Informed Consent Guide to
VP Shunt Insertion
Operation Risks
The operation is generally a safe operation with low surgical risk
• Some of the risks encountered are as follows :
• 1) Ileus
• 2) Infection
• 3) Obstruction
• 4) Malplacement
• 5) Wound breakdown with exposed shunt tubing
• Rare but potentially more serious complications are listed below
• 1) Subdural hematoma
• 2) Intracranial hematoma
• 3) Bowel injury
A Patient / Family Informed Consent Guide to
VP Shunt Insertion
Operation Risks
• Ileus
– As the abdominal cavity is entered during operation, some patients may
have slow gastric and bowel movement post operation and may feeling
of nausea and vomiting. They may not tolerate full meals immediately
post operation. These symptoms usually resolve spontaneously over
time
• Infection
– Post operation symptoms and signs would include fever, vomiting, neck
stiffness, redness along the shunt tract
– Most common organisms are S. epidermidis and S. aureus
– Treatment would be intravenous antibiotics, external ventricular
drainage and removal of shunt
• Obstruction
– Most often due to the head tip is obstructed with cells, choroid plexus, or
debris. Diagnosis is based on recurrent signs of headache, vomiting and
drowsiness confirmed by CT scan of the head or lumbar puncture
– Treatment usually entails revision of shunt
A Patient / Family Informed Consent Guide to
VP Shunt Insertion
Operation Risks
• Malplacement
– This occurs when the ventricular or peritoneal end of the shunt
tubing is in a position which does not facilitate free flow of
CSF. The result is poor CSF drainage and hydrocephalus
does not resolve.
• Wound breakdown/shunt tube exposure
– This can occur when the wound does not heal well or the
overlying skin is thin with minimal subcutaneous tissue layer
resulting in wound breakdown. Some Risk factors –
malnourishment, debilitated condition, prolonged steroid
usage.
A Patient / Family Informed Consent Guide to
VP Shunt Insertion
Expectation After Surgery
• The outcome from the actual surgery is good.
Hydrocephalus is often associated with other
conditions such as brain tumours, meningitis or
bleeding. These conditions would influence the
patient's prognosis
• The degree of hydrocephalus prior to surgery
will also affect the outcome
A Patient / Family Informed Consent Guide to
VP Shunt Insertion
When is Revision Indicated?
• When the shunt is infected, blocked, broken, exposed or
if it is in a suboptimal position
• When the pressure valve is unsuitable resulting in either
residual hydrocephalus or intracranial hypotension
• Some of the symptoms and signs to look out for
• – fever, headache, nausea/vomiting, CSF
leukocytosis/hyperproteinemia/hypoglycemia, raised
intracranial pressure, hydrocephalus on CT scan or
collapsed ventricles with postural headache
A Patient / Family Informed Consent Guide to
VP Shunt Insertion
What Does It Involve?
• If infected, the entire shunt tubing is removed
and a temporary external ventricular drain is
inserted. A permanent shunt is reinserted once
the infection has cleared with antibiotics
• If blocked, the respective tubing will be replaced
– ventricular or peritoneal
• If valve is suspected to be unsuitable – a new
valve with the appropriate setting is chosen and
inserted
A Patient / Family Informed Consent Guide to
VP Shunt Insertion
