Types of Shunt Systems for Hydrocephalus: What to Know

Shunt systems help manage hydrocephalus by redirecting excess cerebrospinal fluid (CSF) from the brain to another part of the body, where it can be absorbed.  While all shunts perform the same basic function, there are different types designed to fit individual patient needs.  This article explains how each type of shunt system works, when they are used, and how they differ.

Ventriculoperitoneal (VP) Shunt

How It Works:

A VP shunt moves CSF from the brain’s ventricles through a catheter that runs under the skin to the peritoneal cavity in the abdomen – the space outside the intestines/stomach.  The peritoneal cavity absorbs the CSF naturally.

When and Why It’s Used:

• One of the most commonly placed shunts for hydrocephalus.
• Suitable for patients of all ages, from infants to adults.
• Often the first choice because the abdomen provides a large, reliable place to absorb CSF efficiently
• Can accommodate growth in children – longer tubing can be placed into the cavity and ‘unwinds’ as the child grows.

Ventriculoatrial (VA) Shunt (aka Ventriculojugular – VJ – shunt)

How It Works:

A VA shunt moves CSF from the brain’s ventricles through a catheter that runs under the skin to the right atrium of the heart (or sometimes to the large veins draining to the heart – superior vena cava under the collar bone, jugular vein in the neck), where it is delivered into the bloodstream and naturally absorbed by the body.

When and Why It’s Used:

• Considered when a VP shunt is not an option, such as when previous surgeries or medical conditions prevent abdominal drainage, or there is a problem of abdominal absorption.
• An option for patients who have had multiple abdominal surgeries, and it can be difficult to get the catheter into an open area in the abdomen.
• Using the bloodstream provides a consistent way for CSF to be absorbed and does not affect the heart.
• More commonly used for older children, teens, or adults, since the catheter in the vein cannot be made too long, and growing children will need the catheter revised and lengthened.

Ventriculopleural (VPL) Shunt

How It Works:

A VPL shunt moves CSF from the brain’s ventricles through a catheter that runs under the skin to the pleural space in the chest, a space between the lungs and the chest wall. The CSF is naturally absorbed by the pleural membranes.

When and Why It’s Used:

• The pleural space serves as an alternative CSF absorption site.
• More commonly used in older children and adults; very small children may not be able to absorb enough CSF by this method.
• Considered when VP and VA shunts are not suitable (due to infection, poor absorption, difficulty getting the catheter into the space – such as from multiple abdominal procedures or lack of veins).

Lumboperitoneal (LP) Shunt

How It Works:

An LP shunt moves CSF from the lumbar spine (the spinal fluid space in the lower back below the end of the spinal cord) through a catheter that runs under the skin to the peritoneal cavity in the abdomen, where it is naturally absorbed by the body.  Unlike other shunts, it does not drain fluid directly from the brain’s ventricles.

When and Why It’s Used:

• Often used for idiopathic intracranial hypertension (IIH) or syringomyelia.
• Can be an option for some cases of communicating hydrocephalus.
• May be recommended for patients to avoid a ventricular shunt, avoiding placement through the brain.

Comparing the Different Types of Shunts

Long-Term Care and Outcomes

Each type of shunt is designed to manage CSF flow and support long-term health.  While the type of shunt a patient receives depends on their specific needs, all shunts share the goal of maintaining proper CSF balance and reducing symptoms.

Regular follow-ups with a neurosurgeon help ensure that a shunt continues to function properly.  In some cases, adjustments or replacements may be needed, particularly as children grow or if medical needs change over time.

With the right care and monitoring, many individuals with shunts live full, active lives.

Information you can trust! This article was produced by the Hydrocephalus Association, copyright 2025. We would like to thank Bruce A. Kaufman, MD for his valuable contribution and expert input.

This article is designed to provide helpful information on the subjects discussed. It is not intended as a substitute for treatment advice from a medical professional. For diagnosis or treatment of any medical condition, consult your doctor.