Preparing for Shunt Surgery
The thought of having to undergo brain surgery is frightening and can be physically and emotionally taxing. That’s why it’s important to learn as much as you can about the procedure, get to know the medical professionals involved in your care, and know what to expect post-surgery. The best way to prepare for shunt surgery is by thinking about what questions you want to ask your professional healthcare team, and by being prepared to answer any questions they may have for you. By spending some time preparing for your surgery, you can help ensure that you have a successful procedure and recover faster.
The Healthcare Team
There are several people you will meet before surgery.
The neurosurgeon. Surgery is carried out by a neurosurgeon (a specialist in surgery of the brain and nervous system). The surgery usually takes one to two hours. When you meet with your neurosurgeon before the surgery, some good questions to ask are how long the surgery will take, the risks involved, and whether or not they will shave part of your hair. You may also want to ask about how long you will have to be in the hospital, and how soon you can return to your normal activities.
The hospital office staff. When you arrive at the hospital on the day of your surgery, you will meet with a member of the hospital office staff who will make sure all your paperwork is in order. He or she will ask you to sign a surgical consent form, which states that you give your permission for the surgery to be performed. If you are under 18 years old, a parent or guardian will need to sign the surgical consent form for you.
The nursing staff. A member of the nursing staff will review your medical history and ask about any allergies you may have and any medicines you may be taking. It may be helpful to make a list of your medical history, allergies, and medications before you leave for the hospital so you don’t forget. This is especially important for people with hydrocephalus, because a condition associated with hydrocephalus, called myelomeningocele, also known as spina bifida, can cause some people to develop a potentially life-threatening allergy to latex. The nurse will also make sure that you are healthy enough to have surgery by checking your blood pressure, heart rate, temperature, and breathing rate.
The anesthetist. The anesthetist is a healthcare professional whose job is to make sure you do not feel any pain during your surgery. You will actually be sleeping throughout the procedure and wake up after it’s over. Your anesthetist may be a doctor (called an anesthesiologist) or a certified registered nurse anesthetist (CRNA). This person will ask you about your height, weight, and age, as well as about any other surgeries you have had and whether you or a member of your family has ever had a problem with anesthesia.
The anesthetist may also ask you about any allergies you have and any medications you are taking, even though you may have already discussed this with the nurse. He or she may also ask you other questions about your health and physical condition. Be prepared to answer these questions to the best of your ability, and prepare some questions of your own. You may want to ask about the type of anesthesia you will have, how it will be given to you and if there are any side effects.
The Shunt Surgery Procedure
Shunt surgery is a relatively short and uncomplicated procedure that varies slightly depending upon two factors:
- The neurosurgeon’s preference on where to place the upper (proximal) shunt catheter, which is the part that goes into your head. The shunt catheter may enter from the frontal (anterior) or posterior (behind) position.
- The location of the lower (distal) shunt catheter to permit draining of the excess cerebrospinal fluid (CSF) to another part of your body.
When it is time for your surgery, you will be brought into the operating room. There, you will be hooked up to an intravenous (IV) line as well as to one or more devices to monitor you during and after surgery. These devices include:
- Electrocardiogram (EKG) —which monitors your heart rate.
- Automatic blood pressure (BP) cuff—monitors your blood pressure.
- Pulse oximeter-measures the amount of oxygen in your blood.
You will likely be given general anesthesia, either through your IV line or with a special mask placed over your nose and mouth, which will make you fall asleep. A small amount of hair on your head may be shaved and some antiseptic solution will be scrubbed on your head and parts of your belly (or the area where the lower shunt catheter will enter) to help prevent infection.
Small incisions are then made on the head and in the abdomen (in case of a ventriculoperitoneal (VP) shunt,) or the collar bone area (in the case of a ventriculoatrial (VA) shunt) to allow the neurosurgeon to pass the shunt’s tubing through the fatty tissue just under the skin. A small opening is made in the skull to allow the upper catheter to be passed through the brain and into the ventricle.
For a VP shunt, the lower catheter (or abdominal/peritoneal catheter) is passed under the skin through the fatty tissue, coming to rest in the belly through a small opening in the lining of the abdomen where the excess CSF will eventually be absorbed. The incisions are then closed and sterile bandages are applied.
For a VA shunt, the lower catheter is passed under the skin through the fatty tissue using a needle and then is inserted into the right atrium of the heart where the excess CSF goes into the bloodstream. An incision in the collar bone area is closed and a sterile bandage is applied.
NOTE: Ask your neurosurgeon or Advanced Practice Provider (APP) about specific precautions with a VA shunt.
What to Expect After Shunt Surgery
After shunt surgery, you will be moved from the operating room to the recovery room, where a nurse will watch you closely to make sure you are doing all right before moving you to a regular hospital room. The nurse will check your blood pressure, heart rate, breathing rate, and temperature. He or she will also check your brain function by asking you some questions after you wake up from the anesthesia. The nurse will also check your neurologic condition by asking you to move your arms, legs, fingers, and toes.
When you wake up after surgery, expect to feel weak and tired. You will also feel sore if the distal end of your tubing has been placed or changed. This is natural as your body starts to heal. Nurses will be there to help you, and they will want you to get up and get moving soon after surgery to help speed the recovery process. As you get better, you will be allowed to do more things such as eating solid foods again and getting up by yourself to use the bathroom. You will be discharged from the hospital as soon as your neurosurgeon feels you are ready, usually in a day or two after surgery. Your neurosurgeon or APP will give you specific instructions about what you can and cannot do while you are recovering at home.
When you get home from the hospital you will still need to rest. During this time, you will concentrate on building up your strength so you can return to school, which may take a few weeks. Your neurosurgeon or APP will let you know when it is okay to return to all of your usual activities
Outcomes of Shunt Surgery
Shunt surgery is an effective treatment for hydrocephalus. By draining excess cerebrospinal fluid (CSF) from the brain, shunt surgery reduces pressure inside the skull, lowers the risk of central nervous system damage, and relieves the symptoms associated with hydrocephalus.
Once you have a shunt, you always have a shunt, except for a few exceptions such as the few that have a successful endoscopic third ventriculostomy (ETV) after living with a shunt. This means a shunt (and an ETV) is a lifetime commitment. Unfortunately, no shunt lasts forever. There is a 40% shunt failure rate in children within the first 2 years of placement necessitating a shunt revision. A shunt may need to be replaced because of an infection or blockage, or because the shunt valve stops working properly. Fixed pressure valves, which are preset to a fixed pressure, may need to be replaced if the fixed pressure setting no longer matches the person’s needs. In children, a shunt may need to be replaced as the child grows to lengthen the catheter, particularly if it is a VA shunt.
Some shunt valves are programmable and the pressure setting can be changed by using a powerful magnet in a special programming device. However, the magnet from an MRI may affect the setting on a programmable valve. It is important to ask your neurosurgeon or APP if you have a preset or programmable valve so if you need an MRI, you can let radiology know the type of valve you have.
The signs and symptoms that a shunt may need to be replaced are usually the same as the symptoms that were present before the shunt was implanted, but they may also be related to where the lower catheter of the shunt was placed (for instance, in the heart, chest, or abdomen).
Information you can trust! This article was produced by the Hydrocephalus Association, copyright 2021. We would like to thank the following individuals for their valuable contributions and expert input: Marion L. (Jack) Walker, MD, and Cathy Cartwright, DNP, RN-BC, PCNS, FAAN.