Ventriculoperitoneal Shunt

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Dr. Pravina Ushakant Shah

  • MD,Neurologist
  • 40 years experience

Dr. Virender Kumar Khosla

  • MBBS, MS (General Surgery), M.ch (Neurosurgery), FICS, MNAMS
  • 38 years experience

Dr. Pratibha Dutta Singhi

  • MD (Ped.), All India Institute of Medical Sciences, New Delhi (1978), M.B.B.S., JLN Medical College, University of Rajathan, Jaipur, 1973
  • 38 years experience

Dr. Sudesh Kumar Prabhakar

  • DM Neurology-1978
  • 37 years experience

Dr. S.S.K Ayyar

  • FAAN (USA), MD, DM (Neurology)
  • 35 years experience

Dr. Madhuri Behari

  • DM (Neurology) from AIIMS, MD (Medicine) from Lady Hardinge Medical College, Delhi University, MBBS
  • 34 years experience

Dr. Arun Garg

  • D.M. (Neurology), Swai Man Singh Medical College, Jaipur - 2002, M.D. (General Medicine), Swai Man Singh Medical College, Jaipur - 1989, M.B.B.S., Swai Man Singh Medical College, Jaipur - 1986
  • 32 years experience

Dr. Ashis Pathak

  • M.Ch-1987
  • 30 years experience

Dr. Lt(Gen) Ajit Singh Narula

  • DM (Nephrology) Post Graduate Institute of Medical Education and Research, Chandigarh(1989), MD (Medicine) Armed Forces Medical College, Pune (1982), MBBS - Stanley Medical College, Madras (1975), Fellow of American College of Physicians (2008)
  • 30 years experience

Dr. Rajesh Garg

  • MBBS, MD -Medicine , DM ( Neurology)
  • 30 years experience

Dr. V. P. Singh

  • DNB Neurosurgery, National Board of Examinations, 1989, MCh Neurosurgery, All India Institute of Medical Sciences, New Delhi, 1987, MBBS, All India Institute of Medical Sciences, New Delhi, 1982
  • 30 years experience

Dr. Deepu Banerji

  • M.Ch (Neurosurgery)
  • 28 years experience

Dr. Harjinder S Bhatoe

  • M.Ch, MS, MBBS
  • 27 years experience

Dr. Anand Kumar Saxena

  • MBBS - University of Delhi, 1989, MD - Medicine - University of Rajasthan, Jaipur, 1994, DM - Neurology - G B Pant Hospital / Moulana Azad Medical College, New Delhi, 2006
  • 27 years experience

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About Ventriculoperitoneal Shunt

A ventriculoperitoneal shunt (VPS) is also called a cerebral shunt. It is one of the most effective medical enhancements discovered in neurosurgical patient care.  Cerebral shunts are employed to treat hydrocephalus. If left attended, excess cerebrospinal fluid (CSF) can result into increased intracranial pressure (ICP) leading to herniation, intracranial hematoma, cerebral edema, or damaged brain tissue. In case of pediatric patients, untouched hydrocephalus can cause various adverse effectssuch as increased petulance, chronic headaches, learning difficulties, visual disturbances, and in more progressive cases extreme mental retardation. 

Shunts are made up of a valve caseattached to a catheter, the end of which is put in the peritoneal cavity. The major differences between shunts are the elements used to prepare them, the kinds of valve, and whether the valve is programmable or not. Enhancements in the biotechnologies are making advanced changes in shunt components.  These next-gen components are supposed to mitigate shunt malfunctions and enhance neurosurgical patient care.

Conditions that generallyrequire shunting include:

  • Congenital hydrocephalus
  • Tumors resulting into CSF clogging of the lateral or third ventricles, the posterior fossa, and intraspinal tumors.
  • Post-haemorrhagic hydrocephalus
  • Spina bifida causes the growth of hydrocephalus because the cerebellum restricts the circulation of CSF in a development of Chiari Malformation II
  • Congenital aqueductal stenosis is a hereditarydisease which can cause distortions of the nervous system and is linked with mental retardation, seized thumbs, and spastic paraplegia
  • Craniosynostosis happens when the sutures of the skull close prematurely with sutures fusing before the brain stops developing causing a rise in ICP resulting into hydrocephalus
  • Post-meningitic hydrocephalus caused by meningitis can constrain CSF absorption
  • Dandy-Walker syndrome presents with a cystic deformity of the fourth ventricle, hypoplasia of the cerebellar vermis, and an enlarged posterior fossa
  • Arachnoid cysts are a disorder caused when CSF forms a gathering that is imprisoned in the arachnoid membranes causing a block of the usual flow of CSF from the brain resulting in hydrocephalus. Common locations of arachnoid cysts are the middle fossa and the posterior fossa. The most general symptoms are nausea and vertigo
  •  Idiopathic intracranial hypertension is an uncommon neurological disorder affecting nearly 1 in 100,000 people, generally women of childbearing age. It can lead to increased intracranial pressure and sometimes lead to permanent loss of vision.

The ventricles in the brain act likecommunication network of cavities loaded with CSF and situated within the brain parenchyma. The ventricular system is made up of 2 lateral ventricles, the third ventricle, the cerebral aqueduct, and the fourth ventricle. The choroid plexuses placed in the ventricles generate CSF, which plugs the ventricles and subarachnoid space, following a chain of regular production and reabsorption.

The shunt is brought into force by the patient's breathing. On stimulus, the diaphragm slopes toward the abdominal cavity and results intoan increase in fluid pressure in the thoracic superior vena cava. The variation in pressure, generally about 5 cm H2O, revels the shunt valve, enabling the flow of ascitic fluid into the large vein. The activity of the shunt can be improved by the patient's inspiring against pressure, as when using a blow bottle.

One drawback of the shunt is thinning of the blood and a subsequent drop in hematocrit, which requires transfusion of packed cells and maybe a slowing of the rate of flow of ascitic fluid into the venous system. Other intrinsic risks include infection, leakage of ascitic fluid from the operative site, elevated bilirubin, gastrointestinal bleeding, and disseminated intravascular coagulation.

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