Shunt Surgery for Hydrocephalus

What is shunt surgery for hydrocephalus?

Treatment for hydrocephalus with a shunt involves surgically implanting a flexible plastic tube, called a shunt, into the brain or spinal cord to divert excess cerebral spinal fluid (CSF) away from the brain. The shunt is then adjusted and monitored regularly. Shunt placement and management is the most common treatment for hydrocephalus. In some cases, specialists use endoscopic third ventriculostomy.

A ventricular shunt is a flexible plastic tube, about 1/8 inch in diameter, with a valve that controls the flow of cerebral spinal fluid (CSF) draining from the cavities (ventricles) of the brain. The brain shunt gets placed in the lateral ventricle, where it can drain to one of the following areas:

When CSF drains into this area that holds the digestive organs, it gets absorbed into the bloodstream. Placement of a ventriculoperitoneal shunt usually involves fewer risks than other types of shunts.

A ventriculoatrial shunt runs through a vein in the neck into the right atrium of the heart, where CSF flows directly into the bloodstream.

A ventriculopleural shunt diverts CSF into the chest cavity around the lungs.

A lumboperitoneal shunt drains fluid from the space around the spinal cord in the lower back (lumbar spine) into the abdomen.

Shunt systems typically include a programmable valve, which can control the rate of drainage without additional surgery.

How can I prepare for shunt surgery?

You can help make sure your child has the best possible surgery outcome by understanding what to expect before, during and after brain shunt surgery at Gillette Children’s.

Here are a few resources to help you feel more prepared:

Review tips to prepare for surgery at Gillette.
Understand the amenities available at Gillette.

What can I expect during shunt surgery?

A pediatric neurosurgeon implants the shunt’s tubing, which runs from the brain along the neck, just behind the ear, and down to the drainage area where the excess CSF gets reabsorbed. The surgery typically lasts less than an hour.

After surgery, all parts of the shunt remain under the skin. Shunts usually aren’t visible through the skin, except in infants. Following shunt placement, the pressure inside your child’s head (intracranial pressure) returns to normal and the size of their brain’s cavities decreases.

In infants, the space between the bones of the skull (called the fontanel, or “soft spot”) becomes soft and might appear sunken. The gaps (sutures) will narrow or possibly overlap.

Your child will be in the hospital two to seven days, depending on their clinical progress following surgery.

Follow-Up Care After Shunt Surgery

Because hydrocephalus is almost always a lifelong condition, children who have shunts usually need surgeries throughout their lives to adjust, replace or repair their shunts. Our medical specialists work with your family to teach proper shunt maintenance—and how to tell whether or not a shunt is working properly.

Gillette neurosurgeons use programmable shunts to adjust intracranial pressure without additional surgery. We use a magnetic device held over your child’s scalp to make the adjustments. Most shunt systems also have an access area (usually called a reservoir) that lets doctors take samples of CSF using thin needles.

Although shunt surgery usually treats hydrocephalus successfully, you should watch for signs of possible shunt malfunction. Contact Gillette immediately if you notice any of these symptoms:

The most common type of complication is an obstruction along the shunt tube. A blockage can happen when brain or bowel tissue plugs one end of the shunt. Depending on the seriousness of the obstruction, periodic or ongoing symptoms of hydrocephalus will return.

Shunt obstruction requires immediate medical attention. A neurosurgeon will run tests to find the location and degree of a shunt obstruction. The neurosurgeon might need to remove and replace all or part of the shunt system.

Because shunts are foreign objects inside the body, they run a small risk of becoming infected. Signs of infection include redness and swelling along the length of the shunt. To treat an infection, a neurosurgeon will remove the shunt, insert a temporary drainage tube and administer antibiotics. Once the infection clears, the neurosurgeon implants a new shunt. Infected shunts occur in less than 5 percent of surgeries. They usually become obvious within one to six months after surgery.

Shunts can sometimes drain fluid too quickly. This excess drainage usually happens when children are standing. Excess drainage can lead to headaches, vomiting, drowsiness and changes in vision.