What is it?
A programmable shunt is a type of ventriculoperitoneal shunt (VPS) that is used for treatment for hydrocephalus. Hydrocephalus is a neurological disease literally meaning water on the brain and can be very disabling.
What is its goal?
The goal of a programmable shunt is to reduce the abnormally high pressure inside the brain. This is achieved by placing a catheter in the brain that allows drainage of excess fluid into the abdomen. A programmable shunt has an adjustable valve which allows you to modify the amount of fluid drained after the shunt is implanted.
How is it done?
The patient goes to sleep with general anesthesia. A small hole is made in the skull on the top of the head, behind the hairline. A small catheter is directed into the fluid filled cavity in the brain (ventricle). Tubing is tunneled to a place behind the ear where a valve is placed to regulate the flow of fluid.
What are the risks?
The major risks of the procedure are bleeding, infection, damage to normal brain tissue and need for future operation. The risk of bleeding is immediate and will be detected while the patient is still in the hospital. If there is excessive bleeding, a larger surgery may be required to prevent brain damage.
What is the success rate?
The success rates depend on the age of the patient and the reason why the shunt is needed. Generally, there is around a 50% failure rate for ventriculoperitoneal shunts. The shunt tubing can become infected or obstructed requiring surgical revision.
How long will I stay in the hospital?
Depending on the clinical situation, patients are able to go home 2-7 days after surgery.
What is special about the way we deliver this treatment?
The Rochester Neurosurgery Partners shunt failure rates are among the lowest in the country. They are currently performing a study to calculate their exact revision rate and to determine which factors lead to a good outcome. The materials and technology used for this procedure are the newest and most advanced.
How to get a syringe?
The procedure is done as follows: 1 An area of hair on the head is shaved. This may be behind the ear or on the top or back of the head. 2 The surgeon makes a skin incision behind the ear. Another small surgical cut is made in the belly. 3 A small hole is drilled in the skull. One end of the catheter is passed into a ventricle of the brain. This can be done with or without a computer as a guide. It can also be done with an endoscope that allows the surgeon to see inside the ventricle. 4 A second catheter is placed under the skin behind the ear. It is sent down the neck and chest, and usually into the belly area. Sometimes, it stops at the chest area. In the belly, the catheter is often placed using an endoscope. The doctor may also make a few more small cuts, for instance in the neck or near the collarbone, to help pass the catheter under the skin. 5 A valve is placed underneath the skin, usually behind the ear. The valve is connected to both catheters. When extra pressure builds up around the brain, the valve opens, and excess fluid drains through the catheter into the belly or chest area. This helps lower intracranial pressure. A reservoir on the valve allows for priming (pumping) of the valve and for collecting the CSF if needed. 6 The person is taken to a recovery area and then moved to a hospital room.
What is the reservoir on a CSF valve?
This helps lower intracranial pressure. A reservoir on the valve allows for priming (pumping) of the valve and for collecting the CSF if needed.
What are the risks of ventriculoperitoneal shunt placement?
Risks for ventriculoperitoneal shunt placement are: Blood clot or bleeding in the brain. Brain swelling. Hole in the intestines (bowel perforation ), which can occur later after surgery. Leakage of CSF fluid under the skin. Infection of the shunt, brain, or in the abdomen. Damage to brain tissue.
Where is the catheter cut in the brain?
Another small surgical cut is made in the belly. A small hole is drilled in the skull. One end of the catheter is passed into a ventricle of the brain. This can be done with or without a computer as a guide. It can also be done with an endoscope that allows the surgeon to see inside the ventricle.
Why is hydrocephalus surgery done?
Why the Procedure is Performed. Expand Section. This surgery is done when there is too much cerebrospinal fluid (CSF) in the brain and spinal cord. This is called hydrocephalus. It causes higher than normal pressure on the brain.
What happens if a child grows a shunt?
If this happens, fluid will begin to build up in the brain again. As a child grows, the shunt may need to be repositioned. Before the Procedure. Expand Section. If the procedure is not an emergency (it is planned surgery): Tell the health care provider what medicines, supplements, vitamins, or herbs the person takes.
How long does it take to lie flat after a shunt?
The person may need to lie flat for 24 hours the first time a shunt is placed. How long the hospital stay is depends on the reason the shunt is needed. The health care team will closely monitor the person. IV fluids, antibiotics, and pain medicines will be given if needed.
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