PATIENT GUIDE FOR A VENTRICULOPERITONEAL
This is a guide that I hope you will find useful about your upcoming
A "shunt" is a device that allows fluid to travel from
the central part of the brain under the skin into your abdomen.
In general, it is a safe, 45-minute procedure that sometimes does
not even require admission to the hospital. However, we would like
for you to read the below information carefully.
There is no special preparation. You should have nothing to eat
after midnight on the night before the surgery. If you take any
medications in the morning, you should do so with a sip of water
as you ordinarily would. If you are a diabetic, you should take
half your normal dose of Insulin, and have a large glass of orange
juice prior to leaving for the hospital.
When you are in the hospital you will be taken to a holding area
of the Operating Room. An intravenous line will be placed. You will
then be given a sedative that will make you sleepy, and will be
then taken back to the Operating Room at which time you will drift
off to sleep.
After you are asleep,
an inch or so "swath" of hair will be removed from just
behind the hairline on the right side, down behind the right ear,
and down the right side of the neck toward the collarbone. This
generally can be combed over immediately after the surgery, and
should grow back quickly regardless.
curved incision is then made an inch or two behind your right hairline.
It is a small incision and similar to cutting halfway around a quarter.
A small hole is made in the skull about the size of a dime. A tube
about the thickness of a piece of spaghetti and the length of your
little finger, and made of a rubber-like material called silastic,
will be passed into the brain into what is called the "ventricle".
The tube is then guided (underneath the skin) behind the ear, over
the collarbone, and down towards the belly. We will make another
incision just above the umbilicus (belly button) on the right side.
This is about 1 inch in length, and allows us to put the tube into
your belly where the brain fluid is reabsorbed. All incisions are
then closed, often with staples. The shunt is completely underneath
the skin and in general not visible once all has healed.
After the procedure,
you will spend a short time in the Recovery Room where you awaken.
A precautionary CT scan may be obtained. Apart from some moderate
aches and pains where the procedure was done, you will in general
feel the same as before surgery. The decision on when you return
home is made between you, your family, me, and the anesthesia staff.
While in some instances it is safe to return home the same day,
we may keep you overnight due to concern about internal bleeding.
When you return home, you should take it easy for a day for two,
then you can resume normal activities of all kinds.
RISKS OF OUTPATIENT
SURGERY: During my years of surgical training in the 1980s,
the standard of care was to remain in the hospital for several days
after this operation. However, as anesthesia has improved, and as
the operation has become less invasive, many surgeons have begun
performing this as an outpatient. We have sent patients home shortly
after these procedures many times without a single mishap at home
on the night of the surgery. However, like any medical decision,
there are benefits and risks.
is the simple advantage of being in your own home and bed to recover
from the operation. Any painkiller you might receive via an intravenous
in the hospital, you can take as easily by mouth at home. We have
become increasingly concerned about hospital-acquired infections.
There is a particularly dangerous strain called "MERSA"
that is resistant to many of our best antibiotics. The sooner you
go home, the less you are exposed to these kinds of problems. The
main risk is a one percent risk of internal bleeding
or swelling after the operation. In the brain this could cause either
a seizure or stroke, and either can cause death. If the CAT scan
performed after the surgery shows nothing worrisome, we have not
had any problems since we have been treating patients in this manner.
It is your option to
remain in the hospital or return home after your surgery. I recommend
returning home, and waiting until at least 11pm before going to
sleep. If there are any problems, call an ambulance or come immediately
to the emergency room. If you are more comfortable remaining in
the hospital overnight, let our staff know and we will arrange this
The purpose of the shunt is to relieve the pressure caused by the
buildup of fluid inside of the brain. In general, approximately
80% of the time you will feel much improved after the procedure.
You will think and walk much better. Approximately 20% of the time
you will feel no different. It is important to note that it
takes 3 months to determine whether or not this surgery will be
helpful to you, though many people feel better instantly.
have a new generation of shunt that can be slowly programmed. The
maximum setting is 2.5, and the lowest setting is 1.0. One month
from the time of the procedure, we will do a CT scan to see whether
the fluid chambers in the brain (ventricles) have gotten smaller,
and if the shunt (seen as the white linear structure in the brain
in the enclosed picture) is in good position. If all is well, we
start to decrease the shunt setting. We continue until either (1)
you feel much better, or (2) we reach the lowest setting of the
shunt. This takes 3 months, after which time we will know if it
has worked or not.
In general this is a safe operation. There are three main complications,
all of which are rare. The first is infection, which
is the risk of all forms of surgery. In my hands, the risk is approximately
2%, and if it occurs, the shunt usually needs to be removed. On
occasion, the shunt can become blocked. This also
happens very infrequently and if the shunt has been helping you,
the part that is blocked would be replaced.
problem that is most worrisome, but also quite rare, is internal
bleeding after the shunt. The brain is under pressure because
of the excess fluid in its center. When this pressure is relieved,
there can be breakage of a small vein on the surface of the brain
causing what is called a subdural hematoma. This can be quite
serious, and if the subdural hematoma is large, it would
require return to the Operating Room for its removal. This requires
what is called a craniotomy. We have not had to do this in many
If you have any questions,
please do not hesitate to call my office staff or me.
Stephen Saris, M.D.