What is ventriculo-peritoneal shunt?

Ventriculoperitoneal VP shunt surgery is a surgical procedure that involves draining cerebrospinal fluid (CSF) from the central nervous system in cases of hydrocephalus or excess pressure on the brain.



What cases is it used for?

This surgery is performed in cases of symptomatic hydrocephalus with the aim of draining the accumulated cerebrospinal fluid. In cases of acute hydrocephalus, there is no alternative treatment and delaying it can lead to reversible or even permanent brain damage to the patient. In cases of subacute or chronic hydrocephalus, and depending on the age of the patient, an endoscopic ventriculostomy can be considered as an alternative treatment.

What is involved in the operation?

The surgery is performed in an operating room under general anesthesia. It involves placing a catheter, through a small hole, into a brain cavity called the ventricle, where the cerebrospinal fluid is housed.

This catheter is connected in series to a system with a valve to regulate the flow of CSF. Depending on the type of valve placed, the resistance to the passage of CSF through the system is greater or smaller. The catheter is tunneled under the skin, through the subcutaneous cellular tissue, from the head to the atrium or, more frequently, the peritoneum, where the cerebrospinal fluid is physiologically reabsorbed.

Recovery and rehabilitation

The recovery process varies according to the type of hydrocephalus the patient has.


Acute hydrocephalus

Recovery depends a lot on the type of pathology that caused the hydrocephalus, usually it is a tumor or due to acute bleeding. Recovery will depend on the patient's previous neurological state.

Sub-acute or chronic hydrocephalus

Recovery is usually quick and the patient can be discharged from the hospital in 24-48 hours. The patient will undergo functional rehabilitation for walking and control of the sphincters. Patients and their families usually see significant improvement in walking by 1 to 3 months after the shunt placement surgery. The recovery of sphincter control and evolution of memory impairment are highly dependent on the patient's previous neurological state.

Risks of the procedure

Like every surgery, there are some risks involved in a ventriculoperitoneal shunt:

  • Intracerebral hemorrhage (up to 3% of cases)
  • Epileptic seizures (less than 5% of cases)
  • Infection including shunt infection  (from 1-10% of cases)
  • Death (less than 2% of cases)
  • Pneumocephalus: air inside the head, usually asymptomatic, which resolves spontaneously.
  • Hyperdrainage: manifests as subdural or epidural hematoma, severe headache, and collapse of the ventricular system.
  • Disconnection or breakage of the system.

Despite the possibility of some of these complications occurring, at Instituto Clavel the extensive experience of our team of neurosurgeons, and use of the latest technology, allows us to perform shunting procedures successfully in the vast majority of cases, and to solve any problems that might occur in relation to it .

Who are the doctors at Instituto Clavel who perform ventriculoperitoneal shunt surgery?

This operation is performed by the following neurosurgeons:


  • C. Petersen, Bahram Mokri, Edward R. Laws. Surgical treatment of idiopathic hydrocephalus in elderly patients. Ronald Neurology Mar 1985, 35 (3) 307; DOI: 10.1212/WNL.35.3.307
  • Meier U, Kiefer M, Neumann U, Lemcke J: On the optimal opening pressure of hydrostatic valves in cases of idiopathic normal-pressure hydrocephalus: a prospective randomized study with 123 patients. Acta Neurochir Suppl 96:358–363, 2006
  • Sharif Vakili MS et al. Timing of surgical treatment for idiopathic normal pressure hydrocephalus: association between treatment delay and reduced short-term Benefit. J Neurosurg sept. 2016.
  • Hydrocephalus after Subarachnoid Hemorrhage: Pathophysiology, Diagnosis, and Treatment. Chen S et al. Volume 2017, Article ID 8584753, 8 pages.
  • C. D. Wilson, S. Safavi-Abbasi, H. Sun et al., Meta-analysis and systematic review of risk factors for shunt dependency after aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery, vol. 126, no. 2, pp. 586–595, 2017.
  • J. D. Hughes, R. Puffer, and A. A. Rabinstein, Risk factors for hydrocephalus requiring external ventricular drainage in patients with intraventricular hemorrhage. Journal of Neurosurgery, vol. 123, no. 6, pp. 1439–1446, 2015.

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