Ventriculoperitoneal shunt to treat hydrocephalus in Jordan
التحويلة البطينية الصفاقية لعلاج الاستسقاء الدماغي
A ventriculoperitoneal shunt is a thin, valve-regulated catheter implanted entirely under the skin to divert excess cerebrospinal fluid from the brain ventricles to the abdominal cavity, where it is absorbed. It is the most widely used treatment for hydrocephalus, the accumulation of this fluid with raised pressure inside the skull. A shunt is considered in infants who show rapidly increasing head circumference, a bulging fontanelle, vomiting, drowsiness and downward-turned eyes; in patients whose fluid pathways have become obstructed after bleeding, infection or a tumour; and in older adults with normal pressure hydrocephalus, which presents with gait disturbance, memory decline and urinary incontinence. The decision is made by a multidisciplinary team of neurosurgeon, paediatrician or neurologist and radiologist, because alternatives must be weighed: endoscopic third ventriculostomy may suit selected cases better, and in normal pressure hydrocephalus the improvement in walking after removing a volume of fluid is measured before committing to an implanted device. Candidacy is determined by clinical examination and imaging, not by reading a page. The limits are essential to understand. A shunt treats the accumulation of fluid, not its cause, and it does not repair brain injury that has already occurred. In most conditions it is a lifelong device that can block, become infected, or over-drain and cause headache that worsens on standing, so lifelong follow-up is needed. It is not a treatment for headache in general, nor for every enlarged ventricle seen on a scan. Two common myths deserve correcting: the tube is not usually temporary and removed after a few months, and families should never pump the valve themselves unless directly taught to do so by the team. The operation is relatively short and performed under general anaesthesia, followed by a brief hospital stay. Keeping the valve identity card matters a great deal, because some valves are programmable and their settings can be affected by MRI scanning and strong magnetic fields.
Procedure steps
- 1
Confirming the diagnosis and choosing the valve
Brain imaging is reviewed to establish the cause and pattern of hydrocephalus, active infection anywhere in the body is excluded, and the valve type and resistance are chosen according to age, cause and the patient's usual posture. Previous abdominal surgery is reviewed, as adhesions may require a different site for the lower end.
- 2
Anaesthesia and planning the subcutaneous route
General anaesthesia is given and a small area of the head, neck, chest and abdomen is prepared with great care, because skin cleanliness is one of the most important factors in reducing device infection. The route of the catheter from head to abdomen is then marked to avoid areas of pressure and sharp bending.
- 3
Placing the ventricular end
A small hole is made in the skull and the catheter tip is passed into the lateral ventricle, guided by measurements, navigation or ultrasound in infants. Free flow of fluid is confirmed before the valve is connected, since correct placement reduces later blockage.
- 4
Connecting the valve and passing the abdominal end
The valve is secured under the skin behind the ear or on the upper chest, the catheter is tunnelled under the skin down to the abdomen, and its end is placed in the peritoneal cavity with enough length to allow for a child's future growth without traction or withdrawal.
- 5
Checking drainage, closure and monitoring
Flow through the whole system is confirmed, the wounds are closed in layers with particular care over thin skin, and the patient is monitored for consciousness, vomiting and, in infants, head circumference. The family is given the valve card and taught the signs of shunt malfunction.
Before the procedure
Tell the team about any previous abdominal surgery or peritoneal infection, and about any current skin, chest or urinary infection, because a device is not implanted while infection is active. List all medicines, especially blood thinners and anticoagulants, and do not stop them on your own. Complete the brain imaging and blood tests before the date. For children, record head circumference, weight, sleep pattern, feeding and vomiting over the preceding days, as the surgeon relies on this information. Bathe as the team instructs and avoid scratches or skin infection at the planned wound sites. Follow the fasting time before anaesthesia, and before you leave clinic ask which valve will be used, ask for its card, and ask which scans are permitted afterwards.
After the procedure
Do not press the valve or repeatedly feel along the tubing, keep the wounds clean and dry, and avoid long baths and immersion until your surgeon allows it. In children, measure head circumference as you were taught and record sleep, feeding and vomiting. Always carry the valve identity card and show it to any doctor or imaging technician, because some valve settings can be altered by magnetic fields and need checking after an MRI. Do not expect every symptom to disappear at once; improvement is measured in weeks. **Seek emergency care immediately** for **headache with vomiting and drowsiness or any change in consciousness**, unusual irritability with a bulging fontanelle in an infant, **rapidly increasing head circumference or eyes turning persistently downwards**, fever with redness, swelling or pain along the tubing in the head, neck or chest, severe abdominal pain with distension, a new seizure, fluid leaking from any wound, or severe headache that appears on standing and eases on lying flat.
Expected duration
Usually 45 to 90 minutes, with a typical hospital stay of two to four days.
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