Cerebrospinal fluid bathes the brain and spinal cord. In some cases, there can be problems with its circulation and/or reabsorption, causing a build-up of pressure inside and around the brain. In some cases, this is called hydrocephalus, and in others, it is called intracranial hypertension. The treatment for this can involve placing a shunt which helps divert the brain and/or spinal fluid in order to relieve the pressure. This fluid is drained from either the ventricles of the brain or spinal sac, into the abdominal/chest cavity or atrium of the heart. The shunt either consists of a single catheter or two catheters and a one-way valve when regulation of flow is required.
For a ventriculoperitoneal (VP) shunt, a small cut is made in the scalp just behind the ear. A small hole is drilled into the skull beneath the cut. A small tube (catheter) is placed into the brain to drain the fluid. For a lumboperitoneal (LP) shunt, a small incision is made in the lower back so that the catheter can be inserted into the spinal sac. Another cut is then made either in the abdomen or chest. The catheter is tunnelled under the skin, and then inserted into the abdominal or chest cavity. The cuts are then closed with sutures/staples.
This procedure requires a general anaesthetic which includes, but is not limited to, the risk of rare complications occurring such as death, coma, myocardial infarction, stroke, DVT/PE, chest infection and reaction (allergic or otherwise) to anaesthetic medications/agents. Your anaesthetist will discuss your specific risks (if any) with you in more detail. If you have had positive or negative experiences with previous anaesthetics or if you have any specific concerns or questions, please discuss these with your anaesthetist.
There are risks and complications with this procedure. They include but are not limited to the following. Common risks and complications (more than 5%) include infection and bleeding. Uncommon risks and complications (1-5%) include inadequate placement of the shunt, shunt infection, shunt blockage, shunt disconnection or malfunction, stroke-like symptoms including, weakness, abnormal sensations such as pins and needles, numbness or pain, leakage of fluid from around the brain, and blood clot in the leg (DVT) which may break off and go to the lungs (PE). If the shunt becomes infected, then because it is a foreign body, it may need to be removed. When the infection is under control, if it is determined that you would still benefit from a CSF shunt, then it can be reinserted at this point. Obese people have an increased risk of wound and chest infection, heart/lung complications, and thrombosis. Excess drainage of CSF can occasionally occur and can lead to intracranial bleeding (subdural haematoma). Despite adequate shunting, your symptoms might not improve, and in some cases can worsen. Rare risks and complications (less than 1%) include epilepsy, and injury to the liver, bowel, lung or heart due to the surgical tunnelling process. Death as a result of this procedure is very rare.
IMPORTANT FOR ALL PATIENTS. If you are on ANY BLOOD THINNING MEDICATIONS such as anti-platelet, anti-coagulant or anti-inflammatory medications, they should be STOPPED ONE WEEK PRIOR TO ANY SURGERY. Examples of these medications include plavix, co-plavix, prasugrel, ticagrelor, asasantin, aspirin, disprin, solprin, astrix, cartia, warfarin, pradaxa, dabigatran, rivaroxaban, apixaban, clexane, heparin, celebrex, mobic, naproxen, indomethacin, diclofenac, ibuprofen.
Similarly, ANY HERBAL OR NATURAL REMEDIES including (but not limited to) traditional Chinese herbal remedies and prescriptions, naturopathic and homeopathic treatments, and supplements (such as glucosamine, garlic, ginger, ginkgo, ginseng, turmeric and fish oil) should be STOPPED ONE WEEK PRIOR TO ANY SURGERY.
If these medications are not stopped, then your surgery may need to be delayed and rescheduled for reasons of safety. If you are unsure about whether you need to stop any of your medications, please ask your doctor.
Depending on your general fitness and your medical co-morbidities, you may require an assessment by physician specialists and an anaesthetist to assess your safety for surgery, before a decision can be made about your suitability for surgery.
PRIOR TO ANY SURGERY, YOU WILL NEED TO FAST. On the night prior to surgery, your last mouthful of food should be prior to 12 MIDNIGHT. On the day of surgery, you can sip clear water up until 4 hours prior to your surgery. You may use this opportunity to take medications that your doctor is happy for you to take. Please check with your doctor, what you should do with your medications and write those instructions here.
You will receive a phone call from the hospital up to 3 days prior to your admission. You will receive instructions on what time to present to the hospital and where to present to. It is important that you arrive at the hospital on time so that hospital staff have adequate time to perform the necessary check in procedures. This is also your opportunity to ask anything specific about the hospital you would like to know in order to help you prepare for your admission.
There will be some discomfort from the incisions, as well is in the soft tissues where the catheter has been tunnelled. This should be manageable with pain medications. This pain should mostly settle within the first week post-operative. You will undergo a CT scan and x-rays post-operatively to assess if the shunt catheters are adequately positioned. If the shunt requires adjustment, then your surgeon may need to discuss further surgery with you.
Your neurologic recovery will largely depend on your pre-operative condition and how responsive your symptoms are. In some cases, you may require a short period in rehabilitation to help aid your recovery. In some cases, some adjustments may need to be made to your shunt to improve its performance. In some cases, the shunt is not able to relieve some or all of your symptoms and there is nothing that can be changed in the shunt to improve this. If you do improve, it can sometimes take up to weeks or months for your symptoms to resolve.
Your surgeon will advise specific post-operative care and convalescence before discharge.
You should keep your wounds covered by a dressing for the first week post-operative. If the dressings become wet, please change them to keep the wound clean and dry. You should see your GP during the first week post-discharge to have your wound and post-operative pain relief reviewed. If there are signs of infection, you or your GP should arrange for you to see your surgeon as soon as possible for review. You should NOT operative machinery or drive a vehicle for at least 3 months post-operative. You should avoid swimming, bathing or climbing alone.
Please contact your surgeon’s rooms within the first week post-discharge to arrange your post-operative follow-up appointment at 6 to 8 weeks after surgery. Your surgeon will advise you at discharge if they would like to see you sooner. Your surgeon may require you to have an x-ray or scan a few days prior to your review as part of your assessment.
If at any stage during the post-operative period you have concerns, then please do not hesitate to contact the surgeon’s rooms, your GP, or present to your nearest emergency department for assessment. Things to be concerned about (but not limited to) include increasing pain, worsening symptoms, swelling or redness in the wounds, and new neurological symptoms such as weakness, pain, pins and needles.
