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INTRODUCTION:  This is a guide that I hope you will find useful about your upcoming surgery.
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.

PREPARATION:  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.

THE PROCEDURE:  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.

A 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.

The benefit 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 for you.

BENEFITS:  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.

You 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.

COMPLICATIONS: 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.

The 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 years.
If you have any questions, please do not hesitate to call my office staff or me.

Stephen Saris, M.D.

Neurosurgery Associates, Inc.
1 Davol Square,
Suite 302
Providence, Rhode Island 02903

(401) 453-3545

FAX (401) 453-3533

Copyright 2015 Neurosurgery Associates, Inc.

Neurosurgery Associates