VP-Shunt PDF

VP- SHUNT(VENTRICULOPERITONEAL SHUNT) A VP-Shunt is a medical device used to treat hydrocephalus,a condition characterized by excess of cerebrospinal fluid(CSF ) in the brain’s ventricles.This excess fluid increases intracranial pressure which can cause brain damage if not treated. Components of a...

VP- SHUNT(VENTRICULOPERITONEAL SHUNT) A VP-Shunt is a medical device used to treat hydrocephalus,a condition characterized by excess of cerebrospinal fluid(CSF ) in the brain’s ventricles.This excess fluid increases intracranial pressure which can cause brain damage if not treated. Components of a VP- Shunt 1.Proximal Catheter: A thin, flexible tube placed in the brain’s ventricle to drain excess CSF 2. Valve: Controls the flow of CSF from the brain to the peritoneal cavity.It is attached to the proximal catheter and prevent overdrainage or underdrainageof CSF. 3. Distal Catheter : Extends from the valve to the peritoneal cavity in the abdomen where it can be absorbed into the bloodstream.It runs under the skin typically down the neck and chest,and ends in the peritoneal cavity in the abdomen, where the CSF is absorbed. How It Works The VP- Shunt diverts excess CSF from the brain to the abdominal cavity,where it is absorbed into the bloodstream and at a controlled rate to maintain normal pressure within the brain. Indications for VP-Shunt VP- Shunt are primarily indicated for: 1. Congenital hydrocephalus(present at birth) 2. Acquired hydrocephalus(e.g from infection such as meningitis,brain tumours,or head injuries) 3. Normal pressure hydrocephalus 4. Haemorrhages Procedure for VP-Shunt Preparation: The patient is put under general anaesthesia Incision and Placement: A small hole is drilled in the skull and the proximal catheter is placed into a ventricle.The valve is positioned under the scalp and the distal catheter is threaded subcutaneously down to the abdomen. Testing and Closure: The system is tested to ensure proper function,then incisions are closed How long does a VP –Shunt stay in? A VP-Shunt,used to treat hydrocephalus can last for several years,often 5 to 10 years or more.However,its lifespan varies depending on individual factors such as the patient’s age,underlying condition,and overall health.Regular monitoring and follow-up with a healthcare provider are essential,as shunt can sometimes fail or become blocked,necessitating revision surgery.  VP-Shunt are likely to require replacement after severe years,especially in small children.The average lifespan of an infant’s shunt is two years.Adults and children over the age of two may not need a shunt replacement for eight or more years.Shunt systems require frequent monitoring and follow-up. Types of Shunts A ventriculoatrial shunt :Moves fluid from the ventricles of the brain to a chamber of the heart A lumboperitoneal shunt:Mmoves fluid from the lower back to the abdominal cavity Where is the VP-Shunt located? A valve is placed underneath the skin,usually behind the ear.The valve is connected to both catheters.When extra pressure builds up around the brain,the valve opens, and excess fluid drains through the catheter into the belly or chest area.This helps lower intracranial pressure. Complications of VP- Shunt Potential complications of VP- Shunts includes: Infection: Bacterial infections can occur requiring antibiotics or shunt replacement Blockage: Shunt components can become blocked,necessitating revision surgery Overdrainage/ underdrainage: Imbalance in CSF drainage can cause headaches,nausea,,or other symptoms. Mechanical Failure: Parts of the shunts system can break or disconnect. Abdominal Components: Rarely, the distal catheter can cause issues in the abdomen,such as perforation of organs. Postoperative Care and Management Regular Monitoring: Follow-up appointments are necessary to monitor shunt function and address any issues early. Symptom Awareness: Patients and caregivers should be educated on the signs of shunt mal- function,such as headaches,vomiting,lethargy,or changes in mental status Imaging Studies: Periodic imaging(CT or MRI scans) may be used to check the position and function of the shunt. Benefits of VP-Shunt VP Shunts can significantly improve symptoms of hydrocephalus,enhance the quality of life,and prevent further brain damage by effectively managing intracranial pressure. Surgical Steps of Ventriculoperitoneal Shunt(VP-Shunt) The surgical procedure for inserting a ventriculoperitoneal shunt(VP-Shunt) involves creating a pathway to divert excess cerebrospinal fluid(CSF) from the brain’s ventricles to the abdominal cavity,where it can be absorbed.Here are the steps involved: 1.Preoperative Preparation: -The patient is evaluated with imaging studies such as CT or MRI to assess the hydrocephalus and plan the shunt placement. -General anaesthesia is administered,and the patient is positioned appropriately on the operating table. 2.Incision and Preparation: -The surgical area,typically the scalp,neck,and abdomen,is shaved and sterilized. -A small incision is made in the scalp behind the ear. 3.Creating the Pathway: -A small burr hole is drilled in the skull to access the brain’s ventricles. -A catheter is carefully inserted through the burr hole into one of the brain’s ventricles.This catheter will drain excess CSF. -The catheter’s position is verified using imaging techniques such as ultrasound and fluoroscopy. 4.Creating the Subcutaneous Tunnel: -A subcutaneous tunnel is created from the head to the abdomen using a tunneling device. -This tunnel will house the distal catheter that carries the CSF from the brain to the peritoneal cavity. 5.Distal Catheter Placement: -A small incision is made in the abdomen. -The distal catheter is inserted through the subcutaneous tunnel and positioned in the peritoneal cavity to drain the CSF. 6.Connecting the Shunt Valve: -A shunt valve is connected between the ventricular(proximal) and distal catheters.The valve regulates the flow of CSF. -The valve is typically placed under the scalp,near the initial incision site. 7.Securing and Testing the System:  -The entire shunt system is tested to ensure proper CSF flow and no leaks. -The catheters and valves are secured in place. 8.Closure: -The incisions in the scalp and abdomen are closed with sutures or staples. -Sterile dressings are applied to the surgical sites. 9.Postoperative Care: -The patient is monitored in the recovery room. -Postoperative imaging(such as a CT scan or MRI) maybe performed to confirm the correct placement of the shunt. -The patient and caregivers receives instructions for postoperative care,including wound care,activity restrictions and follow-up appointments to monitor shunt function. Each is crucial for ensuring the proper function and long-term success of the VP Shunt in managing hydrocephalus Instruments needed for VP- Shunt procedure Foerster Sponge Holding Forcep Gallipot Bard-Parker Scapel Handle No 3 and 7 Backhaus Towel Clip Shunt Passer Dandy Artery Forcep Hudson Brace Hand drill with Perforator and Burr Weitlaner Self Retaining Retractor Alm Wound Spreader Bruns Bone Curette Allis Intestinal and Tissue Grasping Forcep Frazier Sunction Tube Mayo-Hegar Needle Holder Zaufal-Jansen Bone Rongeur Shunt System(Shunt Catheters and Valve) Mayo Dissecting Scissor Metzenbaum Dissecting Scissor Adson-Brown Dissecting Forcep Senn -Miller Retractor Metal Ruler  Artery Forceps(Halsted-Mosquito Artery Forcep,Crile-Rankin Artery ForcepOchsner-Kocher Artery Forcep) Probe with Eye Micro-Adson Dissecting Forcep Operating Scissors Iris Scissor Heavy thooth Dissecting Forcep Image-Guided Navigation System(only for small ventricles)