VP Shunt Removal

VP shunt removal surgery

When a VP shunt is removed, it is a type of surgery to remove a previously existing ventriculoperitoneal shunt (a type of surgery normally done to treat hydrocephalus (excess cerebrospinal fluid [CSF] in the brain). This can be removed because of infection, malfunction, obstruction or excessive drainage.

Indications of VP Shunt Removal

• Shunt infection - is the evidence of fever, erythema, pain, or discharge along the shunt tract.
• Shunt defect or obstruction - resulting in such symptoms as headache, nausea, vomiting or evidence of elevated intracranial pressure.
• Complications of over-drainage - e.g. subdural hematomas.
• Not necessary anymore - in uncommon circumstances, hydrocephalus clears and the shunt is not required any more.

Preoperative Evaluation

• Full neurological examination
• Imaging: CT or MRI of the brain to determine the functionality of the shunts.
• X-ray of the shunt series to ensure the presence of the pathway.
• Ruling-out blood tests.
• Risk discussion and assessment of anaesthesia.

Procedure Details

• Anaesthesia: General anaesthesia is conducted.
• Incisions: Incisions are made on the scales, neck, and abdomen at the site where the shunt catheter is.

Disconnection and removal:

• The ventricular catheter is insidiously pulled out of the ventricles of the brain.
• The last one (distal catheter or peritoneal) is withdrawn with much care out of the abdominal cavity.
• In case of the adhesions, a partial removal can be performed to prevent damage to the organ.
• Closure: Does the incisions get sewn up and sterile dressing is placed.

Recovery Time

• Duration of stay in a hospital: 2-5 days, this is dependent on the situation and complications of the patient.
• Home based recovery: 2-4 weeks.
• Normal activities: Slowly returned to normal on the recommendation of the neurosurgeon.

Aftercare

• Watch fever, headache, vomiting, or swelling on the shunt line.
• Treatment of pain using prescribed drugs.
• Follow-up imaging to ascertain the absence of fluid build-up or complications.
• Slow restoration of normal operation with the help of neurosurgeon.

Factors Affecting VP shunt removal procedure cost India

The cost of removal of a Ventriculoperitoneal (VP) shunt in India will be determined by many factors:

Procedure type, complexity

• In case of the removal done in a basic, straightforward disconnection of the shunt and withdrawn catheter, the price will be reduced. However, when complications (infection, prolonged shunt, adhesions, and several prior operations) are also observed, the operation is more complicated, time-consuming, and expensive.

Hospital type and city

• The premium (or churning) hospitals will be located in major metro areas and will be more expensive regarding facility, ICU, specialist teams, and so on.

Surgeon & team expertise

• In the case the surgeon is extremely specialist/neurosurgeon and has an excellent reputation, the cost will be premium. Also in the case of additional specialists (anaesthesia, ICU team) required. 

Length of stay in hospital/ ICU use

• The length of stay, the length of stay in the ICU, additional monitoring after surgery all increase costs. Moreover, in case of complications (infection, bleed) stay goes up as well.

Diagnostics, preoperative as well as postoperative care

• Pre-operative (CT/MRI, labs), imaging, post-operative imaging, medication, dressing, surveillance, etc.

Implants / gadget / replacement device

• Removal might be easier; however, in case the system requires substitution (or programmable valve) the problem of the device becomes quite expensive. Also, in case a programmable shunt had been initially installed.

Complications & revision requirement

• In case of infection, revision before, with several parts of the shunt, the costs increase.

Room category & amenities

• Costs more are the private deluxe rooms, single occupancy, special nursing etc. Standard ward is cheaper.

International patient services / medical tourism

• When you are an international immigrant, or buy medical tourist packages, it could involve additional expenses (organization, translation, airport transfer etc) but in most cases removal is a domestic matter. There are estimates on premiums of international patients.

VP shunt removal surgery risks

Removal of VP shunt is usually a safe procedure in the hands of a skilled neurosurgeon though as in all surgery, there are always risks involved. The risks can be different according to the age of the patient, underlying condition, the length of time that the shunt has been present, and infection or prior surgeries.

Infection

• Description Infection may occur at the site of incision, through the shunt tract or in the cerebrospinal fluid (CSF) resulting in meningitis or ventriculitis.
• Risk Factors: preexisting shunt infection, immunocompromised patients, extended surgery.
• Prevention: Sterile operations, preventive drugs, and close follow-up.

Bleeding / Hemorrhage

• Description: Bleeding may happen during removal of the scalp, brain (ventricle) or abdominal cavity in case peritoneal catheter removal is a challenging task.
• Symptoms: Acute headache, neuro-disability, abdominal pain, oedema.
• Treatment: Surgical management of bleeding and care.

Cerebral Spinal Fluid (CSF) Leak

• Description: The withdrawal of the ventricular catheter may at times lead to leakage of CSF via the incision or scalp.
• Complications: Can cause pseudomeningocele or predispose infection.
• Treatment: In most cases, it is treated with wound care; in severe instances, they may need temporary draining or re-operation.

Hydrocephalus Recurrence

• Description: In case the shunt was still required then the removal can lead to recurrence of the hydrocephalus.
• Symptoms: Headache, nausea, vomiting, lethargy, visual disturbances.
• Treatment: Surface monitoring; might need replacement or new shunting.

Neurological Complications

• Description Rarely brain tissue can be damaged during the removal of ventricular catheters.
• Symptoms: including weakness, seizures, cognitive impairments or other neurological impairments.

Abdominal Complications

• Description: Abdominal organs can be damaged or adhesions may form as a result of removing the distal catheter out of the peritoneal cavity.
• Symptoms: Painful swelling, bowel problems.
• Treatment: Surgical correction in severe cases; in most cases, minor problems can be treated conservatively.

Anaesthesia-Related Risks

• Description: The dangers of general anaesthesia may be allergy, breathing complications, or cardiovascular complications.
• Risk Factors: Pre-existing heart/ lung disorders, age.

Wound Healing Problems

• Description: The sites of incision can take a long time to heal, become red, or get a scar.
• Treatment: quality wound care, antibiotics (infected).

Best hospital for VP shunt removal India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

VP shunt removal recovery time

Postoperative outcome is related to age, general condition, and the purpose of the removal, the existence of complications, and the insertion of a secondary shunt after the first one.

Hospital Stay

• Length of stay: 2- 5 days in basic shunt repair.
• Prolonged hospitalization: It may be required in case it was infected, bleeding, or had some other complications.
• ICU care: It is needed sometimes to monitor, particularly in children or patients with underlying neurological conditions.

Initial Recovery at Home

• Length: 2-4 weeks of light exercise.

Focus:

• Peri-incisional hygiene and infection surveillance.
• Treatment of pain using prescribed drugs.
• Progressive resumption of light activities.

Neurological Recovery

• Symptoms to be observed: headache, vomiting, nausea, dizziness, vision changes or even lethargy.
• Hydrocephalus follow-up: In case the shunt remained, the symptoms can repeat again and follow-up imaging would have to be performed.

Full Recovery

• Majority of patients: 4-6 weeks of full physical recovery.
• Influencing factors to full recovery:
• Age and general health.
• Indication of shunt removal (infection vs. elective removal).
• Any complications in the course of the operation (bleeding, CSF leak).

Follow-Up

• Neurosurgeon visits: The visits occur regularly every 1-2 weeks after the surgery and after that, periodically to monitor.
• Imaging, CT or MRI can be performed to assure that there is no stasis in CSF circulation.
• Physical activity: Progressively increased according to the recommendation of a doctor; it is not recommended to engage in heavy lifting or other hard physical work in the first weeks.

Conclusion

VP shunt removal is a very delicate neurosurgical operation undertaken with the aim of correcting a malfunctioning shunt, infection, over-drainage or when the shunt is not necessary any more. Although relatively safe, it has risks in the form of infection, bleeding, CSF leak, recurrence of hydrocephalus, and neurological complications. A typical hospital stay of 2-5 days is followed by 2-6 weeks of progressive home rehabilitation which depends on personal health and the complexity of the surgery. It is necessary to reduce the number of complications and offer the highest results with a careful preoperative examination, an experienced surgical hand, and attentive observation of the patient after a surgical procedure. It is possible to achieve successful recovery and increase quality of life after shunt removal with proper follow up and care in most patients.

VP shunt removal surgery in India with GetWellGo

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FAQ

Is there a recurrence of hydrocephalus?

• Hydrocephalus might recur in case the shunt is required still. Imaging is used to monitor the patients, and a new shunt can be placed in case it is necessary.

Is the surgery painful?

• Surgery is done using anaesthesia to control pain and later drugs are used. First few weeks: It is normal and mild discomfort at incision sites.

Are there alternatives of shunt removal?

• Shunt revision or replacement can also be done in place of complete removal in certain cases.
• Only in case of no symptoms or complications, it can be a choice of conservative management.

Is it possible to eliminate the shunt completely in all instances?

• Not always. In case of adhesion, or danger of organ trauma, partial resection can be carried out to prevent complications.