Ventriculoperitoneal Shunt Management

Juan Sales-Llopis Neurosurgery Department, General University Hospital of Alicante, Spain

• Adjustable differential pressure versus adjustable gravitational valves in pediatric hydrocephalus
• Effectiveness of single-stage shunt replacement for Cutibacterium acnes CSF shunt infection
• Resolution of tension pseudomeningocele complicating foramen magnum decompression for Chiari I malformation after ventriculoperitoneal shunt: A case report
• A minimally invasive technique for ventriculoatrial shunt placement
• A novel perspective on dissemination: somatic metastasis of germ cell tumors from the central nervous system
• Integration of continuous lumbar drainage and third-generation EGFR-TKI in managing leptomeningeal metastasis-induced life-threatening intracranial hypertension: a case report
• Burden of pediatric neural tube defects at a referral medical center in Tanzania
• Implications of the glymphatic system in the diagnostic and surgical workup of normal pressure hydrocephalus

• Pre-op imaging (CT/MRI) to evaluate ventricular anatomy
• Antibiotic prophylaxis
• Valve selection based on age, pathology, and revision history
• Intraoperative confirmation of ventricular catheter placement (navigation or ultrasound if complex)

• Immediate CT scan to confirm catheter position, rule out pneumocephalus or hemorrhage
• Clinical improvement in hydrocephalus-related symptoms
• Wound inspection and signs of infection
• Shunt series X-rays if malfunction is suspected

• CT scan: ventricle size changes (enlargement or slit ventricles)
• Shunt series: assess continuity and positioning of components
• Valve interrogation with programming device (if applicable)
• Radionuclide shunt study for functional assessment
• Reservoir tap: opening pressure, CSF clarity and cell count

• Infection or obstruction → full shunt system removal often necessary
• Isolated component failure → partial revision may be sufficient
• Infection: remove shunt → place temporary EVD → antibiotics → delayed reimplantation
• Consider ETV as alternative in selected cases (e.g., aqueductal stenosis)

• Clinical assessment: gait, cognition, urinary function
• Periodic neuroimaging as indicated
• Valve pressure adjustments in programmable systems
• Patient/caregiver education on warning signs of dysfunction

In a Letter to the Editor Lu et al. published in the Journal of Neurosurgery to discuss ventriculoperitoneal shunt management strategies for discharged patients ¹⁾.

- Strengths:

1. Highlights a clinically important gap—post-discharge VPS care.
2. Sparks important discussion on outpatient monitoring and follow-up protocols.

- Limitations:

1. Absence of abstract/data: no study design, patient numbers, follow-up length or outcomes described.
2. Lacks novel evidence—appears more observational or comment-based rather than presenting new data.
3. Limited generalizability: single-center or experiential letter format.
4. Without details, it’s impossible to assess validity or applicability.

- Verdict: While raising practical concerns is commendable, the letter’s value is minimal without supporting data. It should not change practice but may prompt more detailed studies or guidelines.

- Be vigilant about VPS patients after discharge—consider structured follow-up. - Recognize the need for standardized outpatient care (e.g., home nursing, telehealth check-ins, valve pressure reviews). - Use this letter as a prompt—not as evidence to alter protocols yet.

- Score: 3/10 – Raises awareness but lacks data, methodology, and actionable insights.

- Bottom Line: This letter draws attention to an under-addressed issue—post-discharge management of VPS patients—but in its current form, offers more suggestion than evidence. A useful conversation starter, but not a practice-changer.

1. WordPress Categories: Letters, Neurosurgery, VPS, Patient Management
2. Tags: ventriculoperitoneal shunt, post-discharge care, outpatient monitoring, neurosurgery letter