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Ventriculoperitoneal Shunt

Medically reviewed by Suzanne Falck, M.D., FACP — By Erica Roth — Updated on October 11, 2017

Causes

Procedure

Recovery

Risks

Outlook

What is a ventriculoperitoneal shunt?

A ventriculoperitoneal (VP) shunt is a medical device that relieves pressure on the brain caused by fluid
accumulation.

VP shunting is a surgical procedure that primarily treats a condition called hydrocephalus. This condition
occurs when excess cerebrospinal fluid (CSF) collects in the brain’s ventricles. CSF cushions your brain
and protects it from injury inside your skull. The fluid acts as a delivery system for nutrients that your
brain needs, and it also takes away waste products. Normally, CSF flows through these ventricles to the
base of the brain. The fluid then bathes the brain and spinal cord before it’s reabsorbed into the blood.

When this normal flow is disrupted, the buildup of fluid can create harmful pressure on the brain’s
tissues, which can damage the brain. Doctors surgically place VP shunts inside one of the brain’s
ventricles to divert fluid away from the brain and restore normal flow and absorption of CSF.
Who needs a VP shunt?

People of any age can develop hydrocephalus and therefore require a VP shunt. However, according to
the Mayo Clinic, hydrocephalus is more likely to occur in babies and older adults. The National Institute
for Neurological Disorders and Stroke (NINDS)Trusted Source estimates that 1 to 2 of every 1,000 babies
are born with hydrocephalus.

Excess fluid can build up around the brain for a number of reasons, including:

overproduction of CSF

poor absorption of CSF by the blood vessels

blockages preventing fluid from flowing throughout the brain

Blockages are the most common cause of hydrocephalus. Cysts, tumors, or inflammation in the brain
can impede the normal flow of CSF and create an unsafe accumulation. Symptoms of hydrocephalus can
include:

large head size

headaches

seizures

irritability

excessive sleepiness

incontinence

poor appetite

cognitive delays or regression

memory loss

poor coordination

impaired vision
Imaging tests can confirm the diagnosis of hydrocephalus. Ultrasound, CT scans, and MRI scans allow
doctors to view the cavities and tissues within the brain. Testing will show if areas of the brain contain
more fluid than normal.

VP shunt procedure

Doctors typically perform the placement of a VP shunt while a patient is under general anesthesia. You’ll
be asleep during the surgery and won’t experience pain. The entire procedure takes about 90 minutes.

Speak to your medical care team about preoperative food and drink restrictions. Older children and
adults may need to fast for at least eight hours prior to surgery. Infants and toddlers may only need to
stop eating baby formula and solid foods six hours before surgery, but they can usually drink water until
four hours before the scheduled procedure. In all cases, these instructions should be reviewed with your
surgical team.

The surgical nurse will shave the area behind your ear in preparation for shunting, as this is where they
will place the catheter. Catheters are thin, flexible tubes used to drain excess fluid. A surgeon will make
a tiny incision behind the ear and will also drill a small hole in the skull. They will then thread one
catheter into the brain through this opening. The other catheter goes behind your ear and is
subcutaneous, meaning it resides under the skin. This tube travels down to your chest and abdomen,
allowing excess CSF to drain into the abdominal cavity, where your body absorbs it. Your surgeon may
attach a tiny pump to both catheters and place it under the skin behind your ear. The pump will
automatically activate to remove fluid when the pressure in the skull increases. It may even be possible
to program the pump, also called a valve, to activate when the fluid increases to a certain volume.

Recovery

Recovery from a VP shunt placement takes three to four days. Most people can leave the hospital within
seven days after the procedure.

During your hospitalization, the hospital staff will monitor your heart rate and blood pressure, and your
doctor will administer preventive antibiotics. Your doctor will make sure the shunt is working properly
before you leave.
Risks of VP shunting

Placement of a shunt is a very safe procedure. However, complications can occur during or after the
procedure. Risks associated with any surgical procedure include excessive bleeding and infection. You
might also experience adverse reactions to anesthesia, such as breathing difficulties, changes in heart
rate, or changes in blood pressure levels.

There are rare risks specific to VP shunting that can be serious and potentially life-threatening if left
untreated, including:

infection in the shunt or brain

blood clots

bleeding in the brain

damage to brain tissue

swelling of the brain

Fever, headache, abdominal pain, fatigue, and a spike in blood pressure levels, or having the same
symptoms that were present when the shunt was initially placed, can indicate an infection or a
malfunction of the shunt. Notify your doctor immediately if these signs and symptoms develop.
According to the University of Chicago, infection is most common in the first few weeks after a shunt
placement.

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Outlook

Shunting is successful in reducing pressure in the brain in most people. VP shunts are likely to require
replacement after several years, especially in small children. The average lifespan of an infant’s shunt is
two years. Adults and children over the age of 2 may not need a shunt replacement for eight or more
years. Shunt systems require frequent monitoring and follow-up. Complications that may occur with
shunt systems include:

mechanical failure

obstructions

infections

Malfunctions can lead to serious complications, such as over- or under-draining of CSF. Over-draining
occurs when CSF drains from ventricles at a faster rate than it’s produced. This can cause ventricles to
collapse, which may lead to headaches or hemorrhage inside the brain. Under-draining allows CSF to
accumulate on the brain and can cause symptoms of hydrocephalus to return. Seek immediate medical
attention if you experience symptoms that indicate your shunt system isn’t working properly.

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Last medically reviewed on August 28, 2017

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Hydranencephaly

Medically reviewed by Seunggu Han, M.D. — By James Roland — Updated on October 18, 2017

Symptoms

Causes

Diagnosis

Complications

Treatment

Outlook

What is hydranencephaly?

Hydranencephaly is a rare birth defect that drastically affects brain development. Babies born with this
neurological condition are missing the right and left hemispheres of the cerebrum. The cerebrum
normally forms the front of the brain. In place of the missing hemispheres, cerebrospinal fluid, or the
fluid that cushions the brain and spinal cord, fills the cranial cavity.
Hydranencephaly is incurable. It’s not uncommon for babies with this condition to die in utero or within
a few months after birth.

What are the symptoms of hydranencephaly?

Babies born with hydranencephaly may have obvious symptoms at birth. In some cases, it may take
weeks or months for obvious signs to appear. One of the most noticeable symptoms of hydranencephaly
is an enlarged head size. Infants with the disease may have increased muscle tone, but limited
movement.

Other common hydranencephaly symptoms include:

seizures and uncontrolled movements

lack of growth

breathing and digestion problems

difficulty regulating body temperature

vision problems

intellectual disability

What are the causes of hydranencephaly?

Hydranencephaly is the result of injury to a baby’s nervous system or an abnormal formation of it. It
occurs during the earliest stages of development in the uterus. But it’s not entirely clear what causes
these problems. Hydranencephaly may be an inherited condition.

One theory about the abnormal brain development is that there’s blockage in the carotid artery. That’s
the blood vessel that carries blood to the brain. However, researchers don’t have an explanation for why
the carotid artery would become blocked.

Other possible causes include:

an infection of the uterus early in the pregnancy

a mother’s exposure to environmental toxins

other circulation problems with the baby

How is hydranencephaly diagnosed?

Diagnosing hydranencephaly isn’t always done at birth. Sometimes it may take a few months before
symptoms become noticeable.

One common diagnostic test is transillumination. This is a painless procedure. During the procedure,
your baby’s doctor will shine a bright light at the base of their head to see if there’s fluid under the skin.
This test can often reveal whether there’s abnormal brain formation.

Your baby’s doctor may also use a special X-ray to take images of your baby’s blood vessels using a dye.
This is called an angiogram. It helps reveal abnormalities with circulation.

Another imaging test your baby’s doctor may use is called a CT scan. This test can provide the doctor a
detailed and layered look at the brain.

What are the complications of hydranencephaly?

Hydranencephaly affects the mental and physical health of a child. There are several conditions that
tend to go hand in hand with hydranencephaly. Among them are:

Asthma or reactive airway disease (RAD): Asthma can’t usually be diagnosed until a child is older, so the
more general diagnosis of RAD is made when there’s an obvious respiratory problem. The specific cause
is unknown.

Cerebral palsy: A group of disorders affecting muscle movement and coordination. Vision, hearing, and
sensation are also often affected.

Constipation: This is sometimes made worse by a limited diet and medications to control seizures.
Diabetes insipidus: A condition in which the kidneys can’t conserve water. Your child will have excessive
urine output and higher sodium levels in their bloodstream.

Failure to thrive: Feeding a child with hydranencephaly is challenging. This then affects overall health,
growth, and survival.

Irritability: This may be related to muscle spasms and gastrointestinal distress.

How is hydranencephaly treated?

Because hydranencephaly currently has no cure, treatment focuses on managing symptoms.

To help remove excess cerebrospinal fluid from the brain, a surgeon can place a shunt, or one-way
valve, inside the skull. The shunt is attached to a catheter, a flexible tube. The catheter will run into the
abdominal cavity, where the fluid is transferred from the brain. This procedure can help relieve painful
pressure inside your child’s head. It may also prolong life.

Seizures can be treated with medications, including anticonvulsants, as well as other therapies. Diet and
calming techniques can sometimes reduce seizures, too.

Calming and relaxation strategies may also help reduce irritability. Medications, such as stool softeners,
may also be helpful in treating constipation.

It’s important that treatment for all symptoms and complications are coordinated by your child’s doctor.
This will help to avoid overmedication or unwanted side effects from multiple medications and
procedures.

What is the outlook for hydranencephaly?

Each case of hydranencephaly is unique. The condition may be so severe the baby doesn’t survive
pregnancy.

But there are more cases of children living for a few years with hydranencephaly. Still, the odds of
reaching adulthood are slim. The emotional impact of having a child with hydranencephaly is profound.
Don’t hesitate to seek counseling and support to help you get through this challenging chapter in your
life.
Research into the causes and prevention of fetal neurological diseases continues. Information about
research, clinical trials, and resources for patients and families affected by hydranencephaly is available
at the National Organization for Rare Disorders.

Last medically reviewed on July 24, 2017

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What Is Pelvic Congestion Syndrome (PCS)

Medically reviewed by Stacy A. Henigsman, DO — By Becky Young — Updated on March 30, 2022

Symptoms

Causes

Risk factors

Diagnosis

Treatment

In pregnancy

Outlook

Pelvic congestion syndrome (PCS) is a chronic condition that occurs when varicose veins form below the
abdomen within the pelvic region. Varicose veins are veins that become swollen, twisted, and
lengthened as a result of poor vein function.
The syndrome often causes constant dull pain in the pelvic area that’s said to worsen at different times
and in varying situations. It’s more likely to develop in people who have previously given birth.

Experts believe it can be the source of pain in up to 30 percentTrusted Source of people who have
chronic pelvic pain.

What are the symptoms of PCS?

People with PCS generally report that the dull pain is chronic but that it worsens in certain situations,
including:

after standing up for a long time

in the days leading up to menstruation

in the evenings

during and after sexual intercourse

in the late stages of pregnancy

Besides the pain, people may experience other PCS symptoms as well as different combinations of these
symptoms. The severity can also vary quite widely between individuals. These symptoms can include:

dysmenorrhea (painful menstruation)

abnormal bleeding during menstruation

backache

depression

fatigue

varicose veins around the vulva, buttocks, and legs

abnormal vaginal discharge

swelling of the vagina or vulva

tenderness of the abdomen

increased urination

irritable bowel symptoms

hip painTrusted Source

What causes PCS?

Pregnancy is currently thought to be the most common cause of PCS. There are many reasons why
pregnancy might bring this condition on:

Pregnancy can cause structural alterations in the pelvis. These changes can affect some blood vessels,
and that increases the risk of developing varicosities.

Another reason is that the body usually gains fluid and weight to support the baby. Sometimes the veins
can’t cope with the volume of fluid. They then become engorged to the extent that the valves are
damaged and blood can then flow back through them, which causes them to become varicose.

A reason pregnancy is thought to cause PCS is because the rise in estrogen weakens the blood vessel
walls.

What are the risk factors for PCS?

While pregnancy is the main risk factor for anyone, there are other risk factors for developing PCS.
These risk factors include:

more than one pregnancy

hormonal changes

having a “tipped” or retroverted uterus

polycystic ovaries

extra weight in the legs

How is PCS diagnosed?

PCS can be quite difficult to diagnose, and doctors often need to carry out multiple diagnostic
procedures to eliminate other possible causes for your symptoms. These procedures can include:
ultrasound

laparoscopy (a surgical procedure that uses small cameras to look inside the pelvis)

CT scan

MRI scan

venogram

The ultrasound is often preferred as the first step in diagnosing PCS as it’s possible to detect the
varicosities as well as assess the blood flow.

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What are the treatment options for PCS?

Treatment for PCS is usually aimed at reducing and alleviating symptoms. There’s no definite cure for
the condition, and it can be challenging to treat.

Medications available to help relieve your symptoms can include:

nonsteroidal anti-inflammatory drugs (NSAIDs)

chronic pain medications (such as gabapentin plus amitriptyline)

Currently, the most successful treatment is a minimally invasive surgical procedure called pelvic vein
embolization (PVE). This procedure blocks off certain varicose veins that are believed to be the source of
pain.

Studies have shown significant improvementTrusted Source of symptoms in people who have had PVE.
As with any procedure, there are risks, and this treatment option may not be appropriate for everyone.

PCS in pregnancy

The symptoms of PCS often get worse in the late stages of pregnancy as the baby gets bigger and
heavier. Additional pressure is put on the varicose veins in the pelvis, which often leads to an
intensification of the pain caused by the condition.

What’s the outlook for people with PCS?

PCS isn’t a condition that affects your life expectancy, but it does have the potential to significantly
affect your quality of life.

Symptoms like chronic pain, pain during sexual intercourse, and dysmenorrhea can lead to a decrease in
physical activity, loss of function, and depression.

A diagnosis doesn’t necessarily mean you’ll be affected to this extent — PCS varies greatly in terms of
severity.

Keep in mind that there are treatments available to minimize your symptoms and help you cope with
this condition. Talk with your doctor about your options.
It’s also important to talk with your doctor about counseling, if needed, to help you cope with the
significant chronic pain that can go along with having PCS.

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Last medically reviewed on March 30, 2022

ParenthoodHealth & Well-being

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Carotid Artery Surgery

Medically reviewed by John A. Moawad, MD, FACS — By Anthony Watt — Updated on August 3, 2021

What is it?

Purpose

Preparation

Procedure

Recovery

Takeaway

The carotid arteries, which are located on either side of your neck, provide your face and brain with the
oxygen-rich blood they need to function properly.

Without this blood flow, your brain cells would die. When blood flow to an area of the brain is restricted
or blocked, it may lead to a stroke. Strokes may cause temporary or permanent mental and physical
impairment and can be fatal.

What is carotid artery surgery?

If you have carotid artery disease, a substance called plaque — which is composed of compounds such
as fat, cholesterol, and calcium — builds up in your carotid artery and narrows the artery. This
narrowing is referred to as a stenosis and can restrict the flow of blood.

Pieces of this plaque may break loose and travel to a smaller artery in the brain. If this happens, it may
cause an embolism. If the narrowing is significant enough, it can completely cut off blood flow to the
brain and cause a stroke.

A surgery called carotid endarterectomy (CEA) is one way to remove blockages to the normal flow of
blood and to minimize your risk of a stroke. A CEA is also known as carotid artery surgery.
Purpose of carotid artery surgery

Carotid artery disease can lead to a stroke. These blockages can be caused by plaque or by a blood clot
that has clogged the artery. By performing a CEA, your doctor helps to keep blood flowing to your brain
in order to prevent strokes.

Carotid artery surgery also helps prevent a transient ischemic attack (TIA). A TIA has the symptoms of a
stroke — such as numbness, difficulties with speech or vision, and trouble walking — but they last for a
brief time.

According to the National Institute of Neurological Disorders and StrokeTrusted Source, symptoms of a
TIA usually disappear within an hour but may persist for up to 24 hours. Like a stroke, a TIA is caused by
a temporary blockage of blood to the brain.

Your doctor might recommend CEA if you meet certain criteria, such as when:

you’ve already had a stroke

you’ve already had a TIA

the blockage of your carotid artery is severe but not complete

Preparing for carotid artery surgery

In the days before the surgery, your doctor may want to conduct tests that will give them a better
picture of your arteries. Tests used to prepare for a CEA include:

Carotid ultrasound. Sound waves are used to create a picture of the artery and measure the blood flow.

Carotid angiography. This invasive X-ray procedure uses dye to highlight the artery, making the
blockages visible.

Magnetic resonance angiography (MRA). Magnetic and radio waves create a picture of the artery,
sometimes with the use of contrast dye to get a clearer image.
Computed tomography angiography. X-rays provide a 3D picture of the arteries using dye as well.