A shunt is a piece of man-made silicon tubing linking the brain or spinal fluid to another fluid-filled body cavity normally linked via a valves to restrict the flow.
The head or cranial part of the surgery involves a scalp wound commonly behind the right ear where a small hole is drilled through the skull, the meninges opened, and a fine piece of silicon tubing placed into the lateral ventricle (lake) of the brain.
If a spinal shunt is required a small scar allows an opening through the back bones of the spine (laminotomy) to access the spinal canal. This is connected with sutures to a valve that is selected by the surgeon to fit the criteria for that particular patient and can be fixed or variable in its setting.
The tubing is normally passed into the peritoneal sac of the abdomen to create a ventriculo-peritoneal shunt (VP shunt). This requires a small abdominal scar and careful dissection to place the peritoneal catheter in the fluid filled space of the abdomen. Alternatively, the shunt can be placed into heart chambers (ventriculo-atrial VA shunt) or the fluid lining of the lungs (ventriculo-pleural shunt).
The risks involved with the procedure are of problems such as haemorrhage or infection to cause brain or spinal cord damage (<2%). All shunts are covered with antibiotics, and the silicon tubing is also impregnated with antibiotics, to minimise this risk. If a shunt is infected or becomes blocked it needs to be removed and revised.
The shunt tubing can be felt under the skin behind the ear and over the collarbone but is normally lived with harmoniously. Patients can play sport but probably best to avoid contact sports. An alternative to a shunt for cases of obstructive hydrocephalus is an endoscopic third ventriculostomy (ETV) which bypasses the obstruction and obviates the need for tubing.
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