Hydrocephalus is a condition where there is excess cerebrospinal fluid (CSF) in the brain, colloquially known as 'water on the brain'. This is commonly due to obstruction of the CSF pathways. Treatment for hydrocephalus includes placement of a ventriculoperitoneal shunt (abbreviated to 'VPS'), which enables CSF to be safely drained to another part of the body, such as the abdominal cavity where it is absorbed.
Before all neurosurgical procedures, including the procedure for the placement of a ventriculoperitoneal shunt, you should…
- Inform our office straight away if you develop any symptoms of infection, e.g. a cold or flu, before surgery, or if you are receiving treatment for an infection. This is extremely important to prevent shunt infections
- “Nil by mouth” (i.e. nothing to eat or drink) from midnight the night before the procedure. You may take medications with very small sips of water before the procedure.
- Blood thinners should be ceased ahead of the procedure – Please notify your doctor so the pre-operative instructions will be given to you.
- Avoid any non-steroidal anti-inflammatory medication (NSAIDs) one week ahead of the procedure.
- Dental treatment (within three weeks) or any other form of surgery (within three months) of the planned procedure should ideally be postponed.
Placement of a ventriculoperitoneal shunt is conducted under general anaesthesia and normally takes approximately one hour. A small incision is made behind the ear and then a small hole (burrhole) is drilled in the skull. A catheter (a thin tube used to drain away fluid) is inserted through the burrhole into the ventricle, a fluid space in the brain. A second catheter is then threaded down to the abdominal cavity to allow excess cerebrospinal fluid (CSF) to drain safely there. The two catheters are then connected to a miniature pump/valve that controls the flow rate through the shunt. Some shunt valves can be adjusted with an external magnetic device, which can change the pressure at which the shunt automatically activates and drains CSF.
Most patients will need to stay in hospital for up to 3 to 5 days after the procedure. After the procedure it is important to recognise the symptoms of possible shunt malfunction and infection. These are…
- Persistent headache.
- Balance / coordination issues.
- Swelling, tenderness near catheter tract (indicating possible infection).
- Personality changes.
- Fever, with temperature greater than 38 degrees.
Risks associated with this procedure include standard risks of undergoing any surgery. In addition, risks related to brain surgery, including…
- Brain haemorrhage.
- Infection of shunt / brain.
- Shunt blockage or disconnection.
- Damage to brain tissue or bowel.
- Consequences of hydrocephalus – brain swelling, breathing problems, changes to heart rate / blood pressure.
An alternative treatment for hydrocephalus is the endoscopic third ventriculostomy procedure.