All You Need To Know About Brain Shunt Surgery

Brain shunt surgery is a surgical procedure to divert excess cerebrospinal fluid away from the brain and into other parts of the body.

It’s necessary for people with hydrocephalus, in which too much cerebrospinal fluid accumulates in their brains. Brain shunt surgery can keep a person from becoming mentally impaired or having seizures. It also prevents death and stroke, because it will lower intracranial pressure, which is caused by the accumulation of cerebrospinal fluid inside the head as a result of malfunctioning valves.

The most common type of shunt is one that goes from the brain to another part of the body, such as the abdomen. The second type of shunt, called ventriculoperitoneal, is placed inside fluid-filled spaces in your brain. Before you have this kind of shunt, your doctor will assess whether you’re a candidate for it. He’ll also try to select one type of shunt over another based on his specific knowledge about your condition and medical history.

Shunts are inserted into the head during operations that last about an hour. Traditionally, these operations are performed through a large cut made in the skull (craniotomy). Inside the skull, surgeons will use X-rays and ultrasound to precisely target the shunt’s tip. The brain shunt surgery cost is around 2- 4 lakhs.

How does shunt surgery work?

A shunt that goes from the brain to another part of the body is most commonly left in for life. A ventriculoperitoneal shunt is removed through a cut made in your stomach or chest area. This type of shunt is left in place only as long as you need it. The VP shunt surgery costs around3-6 lakhs

Most shunts consist of a catheter with small tubes on each end, one going into your brain, and one leading out to another part of your body, such as a vein in your neck or abdomen. The shunt passages are made of silicone, plastic, and other soft materials.

Shunts can go through any part of the body except your brain. For example, one type of shunt empties cerebrospinal fluid from the head into a large vein in the chest area (this is called a ventriculoperitoneal shunt). The pressure inside your skull then becomes equal to the pressure in the chest, which makes it unnecessary for excess fluid to seep from your brain into your skull. The catheter continues down through your neck and abdomen to an opening in the abdominal region. This opening is called a shunt valve because it serves as a valve between your brain’s fluid compartment and your bowel’s fluid compartment.

People with hydrocephalus, who are candidates for this type of shunt, may have a tube called a ventriculoatrial shunt placed between the brain and the atria of the heart. This type of shunt redirects excess cerebrospinal fluid to the heart only when you’re upright and may need the fluid because it increases your blood pressure. When you lie down, very little pressure pulls cerebrospinal fluid into your heart, so no more than usual seeps from your head and flows through this second shunt.  The valve in this shunt closes when you’re upright to prevent fluids from flowing back into your head from your heart.

Some shunts are implanted as permanent devices while others are inserted temporarily. The shunt or shunt placement is done in a hospital operating room and most patients stay in the hospital for 3 to 4 days after surgery.

The shunt is then connected to a drainage system that will drain cerebrospinal fluid from your head and route it through the catheter into an external collection reservoir.  (this is the valve at the end of the external tubing)

Shunts typically take about one hour to be installed depending on where they are being placed, the number of craniotomies, and other surgeries that may be performed during your brain surgery.

After the shunt is inserted, you will be taken to the intensive care unit (ICU) where your vital signs will be monitored and you may receive medicines to reduce your pain or discomfort. You will also undergo a series of tests, including tests to determine whether your shunt is working well enough to reduce brain pressure. The results of these tests are helpful in monitoring the success or failure of your shunt and in deciding whether to repair or replace it.

Shunts are typically only installed when there are very specific problems that can be treated by shunting – not just because hydrocephalus may one-day cause problems.

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If your shunt is working the way it should, you probably won’t need it removed. However, if there are signs of damage to the shunt (e.g., signs of infection, leaking fluid), your doctor can remove your shunt and replace it with a new one or connect it to a different type of external drainage system. Also, if you have a second surgery on the same day as shunt surgery, the surgeon may want to test your new shunt before any more surgeries are done.

Conclusion

Certain groups have higher rates and complications of shunt failure. Craniotomy greatly increases the risk of infection and damage to the brain and is not recommended in adults with hydrocephalus. With the advent of less invasive neurosurgical techniques such as endoscopic stereotactic surgery (ESWL) in adults, it is expected that a significant decrease would occur in the rate of craniotomy-related damage as well. However, there is no evidence that this has occurred or that ESWL reduces the incidence or severity of intraoperative infection compared to open neurosurgery.

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