What is the VP shunt?

The VP shunt is a commonly performed neurosurgical procedure in India for the treatment of hydrocephalus, a condition in which there is a buildup of excess pressure within the brain.  This procedure aims to transfer excess fluid from within the brain to either the abdominal cavity or the chest region of the body.  The transfer of this excess fluid normalises the intracranial pressure (pressure within the brain)

The shunt system consists of two catheters and a valve, both of which are embedded within the body and not visible from the outside.


Some details about hydrocephalus...

The human brain produces about half a litre (500 ml) of cerebrospinal fluid, also known as CSF, every day. This fluid circulates within the brain, acting as a cushion and also supplying nutrients to brain tissue.  The generation of the cerebrospinal fluid and its absorption/evacuation is normally equivalent, leading to constant pressure within the brain.

The CSF circulates out of cavities in the brain, called the ventricles, bathing the brain and the spine, and is then reabsorbed by the bloodstream.

Hydrocephalus happens when there is an excess of cerebrospinal fluid within the brain, either on account of an obstruction which prevents the fluid from draining out or if there is a lack of absorption of the cerebrospinal fluid by the bloodstream.  Irrespective of the cause, the excessive quantum of the fluid leads to increased pressure within the brain.  This leads to decreased brain function and in the long-term, damage to brain tissue.


Types of hydrocephalus

Hydrocephalus can be of the following types:

Communicating hydrocephalus, in which there is no obstruction in the flow of CSF, but there is a lack of absorption of the fluid back into the bloodstream

Non-communicating hydrocephalus, in which the drainage of the CSF out of the brain faces an obstruction, for example, by a tumour

Adult communicating hydrocephalus, also known as Normal Pressure Hydrocephalus (NPH), which occurs in adults. The cause for this condition is often not identifiable. Secondary NPH has been associated with the occurrence of, or following, brain trauma, meningitis, brain haemorrhage, etc.


How is the VP shunt done in India?

The neurosurgeon drills a tiny hole through the skull and inserts a catheter into the ventricular cavity of the brain.  The catheter is a synthetic tube that is strong and supple, measuring less than a quarter of an inch.  A second catheter is inserted behind the ear and moved down to the abdominal cavity.  A one-way valve is placed behind the ear and both the catheters are connected to the valve.  The valve is so designed that upon the intracranial pressure reaching a certain level, on account of CSF buildup, the valve opens and allows the CSF to drain into the abdominal cavity.  Once the pressure within the brain is normalised, the valve closes again.  Our associate hospitals in India also offer magnetic programmable valves, whose settings can be calibrated by the neurosurgeon externally without having to perform another surgical procedure.

Our neurosurgeons in India also perform venous shunts, in which the excess CSF fluid is drained into the chest region.  In this case Percutaneous Minimally Invasive Surgery procedure is offered.


Why is a spinal tap done before doing VP shunt in India?

In the case of patients suffering from NPH, the neurosurgeon will perform a spinal tap to draw out some cerebrospinal fluid. This minor procedure in effect simulates the VP shunt procedure.  

The measurement of intracranial pressure before the spinal tap and after the spinal tap will provide a very clear indication about the likely outcome, if a VP shunt procedure were to be performed.


What is the prognosis after VP shunt in India?

In general, VP shunts are extremely successful in bringing down intracranial pressure.  However it is also important to note that in conditions wherein the hydrocephalus is caused by conditions such as a tumour, meningitis, spina bifida, etc the prognosis will not be comparable.


Is the VP shunt procedure done in hospitals in India?

Yes, the VP shunt procedure is commonly done by the neurosurgeons at our associate hospitals across India with success rates on par with international benchmarks.