PATIENT GUIDE FOR A VENTRICULOPERITONEAL
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 into your abdomen. In general,
it is a safe, 45-minute procedure that, in most cases, does not
even require admission to the hospital. However, we would like for
you to read the below information carefully.
You will be asked to shower using a special soap the night before
or the morning of the surgery. It will be given to you by the hospital
at your pre-operative evaluation. You should not eat or drink anything
after midnight before the day of the surgery. You will be instructed
if you need to stop any medications prior to your surgery by our
office staff, and which medications to take the morning of your
procedure, by the nurse at your pre-operative appointment.
When you come into the Operating Room, you will first enter the
Holding Area. You will meet the nursing staff, the anesthesia staff,
and have an intravenous placed. You will then be transported to
the operating room, at which time you will be give medication to
put you to sleep. You will feel and remember nothing of the procedure.
After you are asleep,
a small area of hair will be removed from just behind the hairline
on the right side, down behind the right ear. This generally can
be combed over immediately after the surgery, and should grow back
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, 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 the front of the chest, towards the belly.
We will make another small incision on the right upper abdomen.
This allows us to put the tube into your belly where the brain fluid
is reabsorbed. The scalp incision is closed with a few staples and
the abdominal incision is closed with a surgical glue. 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. 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
most instances it is safe to return home the same day, we may keep
you overnight as a precaution.
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 generally send patients home
shortly after these procedures. However, like any medical decision,
there are benefits and risks.
the simple advantage of being in your own home and bed to recover
from the operation. Any pain medication you might receive via an
intravenous in the hospital, you can take as easily by mouth at
home. The main risk is a 1% risk of internal bleeding or swelling
after the operation. In the brain this could cause a stroke, but
if the CT scan performed after the surgery looks fine, we feel very
comfortable sending patients home. We have not had any problems
treating patients in this manner in over 10 years.
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. Initially,
the shunt is programmed to a setting in which it is essentially
shut off. Your first postoperative appointment is 2 weeks after
surgery. If you are doing well, the shunt will be reprogrammed in
order to allow more fluid to drain. You will be seen 1 month later,
and then as needed, in order to make additional adjustments on your
shunt setting. We will do a CT scan to see whether the fluid chambers
in the brain (ventricles) have gotten smaller, and if the shunt
is in good position.
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.
Components of the
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 placement. The brain is under pressure because of the
excess fluid in its center. When this pressure is relieved, patients
can develop 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. We have not
had to do this in many, many years.
Either the physician assistant
or I are always available, 24 hours a day, 7 days a week, if there
are any questions or concerns after your surgery.
Stephen Saris, M.D.