Shunt Placement Surgery

Shunt placement is surgery to place a small tube in the brain. A shunt carries the extra cerebrospinal [sur-ree-bro-SPY-nuhl] fluid (CSF) from the ventricles of the brain to other areas of the body where it is then absorbed. Normally, the ventricles (spaces in the brain) have just the right amount of fluid in them. With hydrocephalus, this balance is off. The shunt drains off excess fluid that may be putting pressure on the brain. This is a condition called hydrocephalus [hy-drow-SEF-uh-luss]. Hydrocephalus can be caused by a birth defect (such as spina bifida) or a brain injury, infection, or tumor.

After shunt placement, healthcare providers will pay close attention to the patient. They will watch for common complications, such as:

• A blocked shunt (part way or completely)
• Infection

These complications can lead to others, including overdraining or underdraining. Both can cause additional symptoms. If these problems occur, an additional surgery may be needed.

The most common side effects include:

• Headache. Usually, headaches go away after shunt surgery. If the headaches continue, medicine such as acetaminophen (Tylenol®) usually helps.
• Vomiting. Your child may vomit (throw up) after surgery. If your child vomits, their doctor will change what your child eats to clear liquids. The doctor will add other liquids and solid foods as your child is able to eat them. If needed, your child’s doctor may order medicine to control nausea or vomiting.

Removing excess fluid from the brain may help to prevent or minimize problems with thinking, movement, and bodily functions.

Surgery is usually done in the hospital. The surgical care team will give specific instructions on what to do to prepare for the surgery.

The surgeon will place the shunt during surgery in the operating room. General anesthesia will be given so that the patient sleeps during surgery. The area on the head where the shunt will be located will be shaved. The two most common shunt placements are the VP and VA, described below.

• A ventriculoperitoneal [ven-TRICK-you-low-pair- it-tuh- NEE-uhl] (VP) shunt carries extra CSF from the brain into the peritoneal cavity, which is the space in the belly where the belly organs are. The fluid flows into this area and is absorbed naturally into the veins.
• A ventriculoatrial [ven-TRICK-you-low-AY-tree- uhl] (VA) shunt carries extra CSF from the ventricle of the brain into the right atrium of the heart. The surgeon puts a catheter into a vein in the neck and then gently pushes it through the vein and into the heart. The CSF passes from the ventricle and into the bloodstream.

After surgery, the healthcare team will watch your child carefully to ensure that the drain is working properly. At home, the family will need to watch for signs that the shunt is not working properly, or for signs of infection. Early symptoms of a shunt malfunction (shunts that are not working) are:

• Headache
• Vomiting
• Irritability or sleepiness

Infants can have these extra symptoms:

• Swollen or raised soft spot on top of the baby’s head
• Fussy, irritable, or a high-pitched cry
• Feeding problems

Symptoms of a shunt infection are:

• Fever
• Redness or swelling along the shunt tract (the place where the shunt is under the skin)

Anyone who has had shunt placement surgery will need to see one or more healthcare providers on a regular basis. Periodic imaging tests may be recommended to ensure the shunt remains stable and that no problems are developing inside the brain.

Recovery will depend on the whether or not any damage occurred in the brain before or during the surgery. Some people with shunts go on to lead perfectly normal, active lives. Others may have problems with:

• Recurring seizures (epilepsy)
• Speaking, hearing, or seeing
• Memory, learning, and processing emotions
• Walking, sitting, or standing
• Bladder control

• National Institute of Neurological Disorders and Stroke
• Spina Bifida Association
• Hydrocephalus Association
• MedlinePlus
• Brainline: Facts about traumatic brain injury