From the Guidelines
The primary purpose of ventriculo-peritoneal (VP) shunt placement in children is to treat hydrocephalus by diverting excess cerebrospinal fluid (CSF) from the brain's ventricles to the peritoneal cavity, thereby preventing increased intracranial pressure and its associated morbidity and mortality. This procedure is necessary when a child has increased intracranial pressure due to CSF accumulation, which can result from various conditions including congenital malformations, brain tumors, infections, or hemorrhage. The VP shunt system typically consists of three components: a ventricular catheter inserted into the brain's ventricle, a valve that regulates CSF flow, and a distal catheter that delivers the fluid to the peritoneum. By continuously draining excess CSF, VP shunts prevent dangerous pressure buildup in the brain that could otherwise cause developmental delays, cognitive impairment, vision problems, or even death [ 1 ].
Key Considerations
- The procedure is generally performed under general anesthesia and requires lifelong monitoring as shunts may need revision due to infection, obstruction, or as the child grows.
- Early intervention with VP shunt placement is crucial in children to preserve neurological function and allow for normal brain development.
- In cases of shunt malfunction or superinfection, the management approach may involve either a single- or double-staged surgical revision, with the choice depending on the specific circumstances of the case, including the presence of infection [ 1 ].
- The decision to use a single-stage or double-stage approach for shunt revision should be based on the individual patient's condition, taking into account factors such as the presence of infection and the overall health of the patient [ 1 ].
Management of Complications
- Shunt infections should be treated promptly, with consideration given to removing the infected shunt and placing an external ventricular drain (EVD) until the CSF is sterilized, followed by the placement of a new shunt [ 1 ].
- In cases where the shunt malfunction is due to clogging from highly proteinaceous fluid, exploration of the non-functioning shunt and revision may be necessary to restore proper CSF flow [ 1 ].
From the Research
Purpose of Ventriculo-Peritoneal Shunts in Children
The primary purpose of ventriculo-peritoneal shunts in children is to treat hydrocephalus, a condition characterized by the accumulation of cerebrospinal fluid (CSF) in the brain, leading to increased intracranial pressure and potential brain damage 2, 3, 4, 5.
Types of Shunts and Their Effectiveness
- Ventriculo-peritoneal shunts (VPS) are the most commonly used type of shunt, with studies showing that they demonstrate superior overall survival compared to ventriculo-atrial shunts (VAS) 2.
- However, VAS can be a useful alternative to VPS when the abdomen is unsuitable, particularly in older children 2.
- Laparoscopic-assisted placement of VPS tips has been shown to be a safe and effective procedure in children with multiple previous open abdominal VPS surgeries 6.
Complications and Outcomes
- Shunt-related complications are common, with infections being the most frequent type of complication, occurring in up to 14.6% of patients 4.
- Mortality rates vary, with one study reporting an overall mortality rate of 4.59% 4 and another study reporting a mortality rate of 10.6% 5.
- The underlying pathology has a significant impact on the outcome, with congenital causes of hydrocephalus showing better outcomes than other causes 5.
Surgical Procedures and Techniques
- Ventriculo-peritoneal shunt surgery is a common neurosurgical procedure, with studies showing that it can be an effective way to manage hydrocephalus 5.
- Laparoscopic placement of VPS tips can be done safely and effectively in children with multiple previous VPS revisions, allowing for improved visualization and placement of the shunt tip in a virgin area of the abdomen 6.