From the Guidelines
The most common indication for a ventriculoperitoneal (VP) shunt is hydrocephalus, a condition characterized by excessive accumulation of cerebrospinal fluid (CSF) in the brain's ventricles. VP shunts are surgical implants that divert excess CSF from the ventricles to the peritoneal cavity where it can be absorbed into the bloodstream, thereby reducing intracranial pressure. Hydrocephalus may be congenital or acquired, with causes including intraventricular hemorrhage, meningitis, tumors, traumatic brain injury, or subarachnoid hemorrhage. Patients typically present with symptoms of increased intracranial pressure such as headache, nausea, vomiting, altered mental status, gait disturbances, or developmental delays in infants. Diagnosis is confirmed through neuroimaging (CT or MRI) showing enlarged ventricles. The decision to place a VP shunt is made when hydrocephalus is causing progressive symptoms or neurological deterioration that cannot be managed by other means, as seen in cases of cryptococcal meningitis where repeated lumbar punctures or use of a lumbar drain fail to control elevated pressure symptoms 1.
While other conditions such as idiopathic intracranial hypertension (IIH) may also require VP shunt placement for visual deterioration, with VP shunts being the preferred CSF diversion procedure due to lower reported revisions per patient 1, hydrocephalus remains the primary indication. The management of VP shunts, including the decision for single- or double-staged surgical revision in cases of shunt malfunction or superinfection, is critical for patient outcomes, with recommendations favoring a single procedure for malfunction and a two-stage approach for superinfection 1.
Key considerations in the management of VP shunts include the use of neuronavigation for placement, counseling patients about driving restrictions, and the use of adjustable valves with antigravity or antisiphon devices to reduce the risk of low pressure headaches 1. Overall, the placement and management of VP shunts are complex and require careful consideration of the underlying condition, potential complications, and long-term patient care.
From the Research
Indications for VP Shunt
- The most common indication for a VP shunt is the treatment of hydrocephalus, a condition characterized by an accumulation of cerebrospinal fluid (CSF) in the brain 2, 3, 4.
- Hydrocephalus can be caused by a variety of factors, including congenital conditions, traumatic brain injury, and infections 4.
- VP shunts are used to divert excess CSF from the brain to the peritoneal cavity, where it can be absorbed by the body 2, 3.
Types of Hydrocephalus
- Communicating hydrocephalus is a type of hydrocephalus where there is no blockage in the flow of CSF between the ventricles and the subarachnoid space 5.
- Non-communicating hydrocephalus is a type of hydrocephalus where there is a blockage in the flow of CSF between the ventricles and the subarachnoid space 4.