VP Shunt Referral Department
Refer patients requiring VP shunt placement to Neurosurgery. VP shunt insertion is a neurosurgical procedure that requires specialized training in CSF diversion techniques, and neurosurgeons are the appropriate specialists for both initial placement and subsequent revisions 1.
Primary Referral Pathway
- Direct neurosurgical consultation is indicated for all patients requiring VP shunt placement, whether for new hydrocephalus or shunt revision 1.
- The neurosurgery team manages the entire procedure including ventricular catheter placement (typically using neuronavigation), valve selection, and distal catheter positioning 1.
Time-Critical Transfer Considerations
For patients requiring urgent VP shunt placement or revision, specific transfer protocols apply:
- Obstructive hydrocephalus (including blocked VP shunts) constitutes a time-critical condition requiring urgent transfer to a neurosurgical center 1.
- Pediatric patients with blocked VP shunts should be transferred to a paediatric neurosurgical centre, with the regional transport service coordinating acceptance by the neurosurgical team 1.
- During transfer, patients should be stabilized with appropriate airway management and hemodynamic monitoring before neurosurgical evaluation 1.
Multidisciplinary Involvement
While neurosurgery is the primary department, certain situations may involve additional specialties:
- General surgery collaboration using laparoscopy for distal catheter placement has shown a 44% reduction in shunt failure rates, though this represents an advanced technique rather than standard practice 2.
- Interventional radiology may assist with echo-guided placement in special circumstances (e.g., pregnancy), but this remains a neurosurgical procedure 1.
Common Pitfalls
- Do not delay neurosurgical referral for patients with signs of shunt malfunction (headache, nausea, vomiting, altered consciousness, or visual deterioration) 1.
- Recognize that VP shunt complications requiring revision (infection, catheter migration, obstruction) remain neurosurgical emergencies and should not be managed by other specialties 1, 3, 4.
- In pediatric cases, ensure coordination with pediatric neurosurgery services rather than general pediatric surgery 1.