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Brain Shunt - Procedure, Requirements, Types of Shunts, and Their Working Mechanism

Published on Jul 21, 2022 and last reviewed on Jan 18, 2023   -  4 min read


The shunt is a device in the brain to regulate the excess amount of cerebrospinal fluid by draining it into another part of the body, preventing brain damage.

Brain Shunt - Procedure, Requirements, Types of Shunts, and Their Working Mechanism

What Is a Brain Shunt?

There are certain conditions affecting one’s head, resulting in large-scale fluid accumulation inside the brain (hydrocephalus). This excess fluid keeps increasing the pressure inside the head (intracranial hypertension), causing damage to the brain tissue. This is a critical condition that requires immediate medical attention. A brain shunt is a flexible tube the surgeon places inside one brain to drain this excess fluid. The other end of the tube is connected to another part of the body, which can absorb the fluid so that the pressure inside the brain stays regulated. When one’s brain is incapable of regulating the pressure from excess fluid collections, shunting is the best long-term option.

When Does One Require a Brain Shunt?

There are some fluid-filled spaces inside the brain called the ventricles, where a fluid known as cerebrospinal fluid or CSF is produced. Normally, the CSF circulates around the brain and gets absorbed back into the bloodstream so that its volume remains the same. Under certain circumstances, this mechanism fails, and CSF builds up in excess inside the brain. The pressure build-up from this accumulated fluid can go extremely high to the point it can actually damage the brain. This is when surgical placement of a brain shunt is advised to drain the fluid. The excess build-up of CSF can be due to:

  • Overproduction of CSF.

  • Blocks in the pathway inside the brain through which CSF normally circulates.

  • The excess fluid fails to get absorbed back into the blood vessels.

Following are the conditions where one may require shunting:

  1. Hydrocephalus - A condition characterized by an enlarged head, frequent seizure attacks, headaches, drowsiness, incontinence, poor appetite, cognitive issues, behavioral issues, poor coordination, memory, and vision.

  2. Inflammation inside the brain.

  3. Presence of tumors or cysts that block the CSF channel.

  4. Excess bleeding (hemorrhage) inside the brain from trauma to the head.

How Does a Shunt in the Brain Work?

A shunt is a flexible tube in the form of a catheter. It has an inflow catheter that drains the CSF from inside the brain once it is properly positioned. Additionally, there is a valve mechanism connected to the shunt, which regulates the fluid flow while draining. The valve works under preprogrammed pressure levels so that just the right amount of fluid is drained and the normal pressure is maintained. The last part is an outflow catheter that runs under the skin and opens out into another part of the body, where the fluid gets absorbed.

What Are the Common Types of Shunting Mechanisms?

Based on which part of the body the catheter is draining to, shunts are of four types. They are:

  • Ventriculoperitoneal Shunt (VP) - Where the last part of the catheter is attached to the abdomen next to the intestines. The fluid will get absorbed into the blood vessels of this area and excreted through urine.

  • Ventriculoatrial (VA) Shunt - In this type of shunt, the last part of the catheter is fitted into a vein in the neck and guided into the heart. The CSF gets drained into the right chamber of the heart and becomes a part of the circulation. Eventually, it is excreted through urine.

  • Ventriculopleural (VPL) Shunt - Pleura is a membrane that covers the lung that lodges the pleural fluid. The end part of the catheter is connected to the pleural cavity, where it becomes one with the pleural fluid and later on gets excreted through urine.

  • Lumboperitoneal (LP) Shunt - This one is different from the other types since the draining part of the catheter is not inserted into the brain but into the spinal column (intrathecal space). It is connected to the abdomen (peritoneal cavity). From here, just like in a VP shunt, the fluid gets absorbed into the blood vessels next to the intestine and gets excreted through urine.

How Is a Shunt Inserted Into the Brain?

Shunt placement is a surgical procedure conducted after one is put to sleep (general anesthesia). The duration of the procedure is approximately 90 minutes. After shaving a small area of the scalp behind the ear, the surgeon will make a tiny cut and drill a hole into the skull. The draining end of the catheter is inserted through this hole. The tip of the drain is made to reach the fluid-filled space inside the brain. The part with the valve is placed behind the ear under the skin and connected to the first part. The end of the tube is guided to the respective body part, where the fluid will get absorbed. The wounds are closed with stitches followed by bandaging. The individual is put to rest and kept under observation for a few days. Once they leave the hospital, periodic follow-ups are required to make sure the shunt is working properly.

What Could Go Wrong With a Shunt?

Possible risks involving the shunt are:

  1. Shunt Blockage - Blocks inside the shunt, affecting drainage. It may get blocked partially and cause poor drainage or get fully clogged allowing no amount of fluid through the tubes. This leads to accumulation of excess CSF inside the brain and cause damage to brain tissues.

  2. Over Drainage of CSF - When too much CSF is drained too quickly, there may be bleeding inside the brain along with headaches, vomiting, and seizures. Here the space called ventricles inside the brain tend to collapse.

  3. Under Drainage of CSF - If adequate drainage does not happen with the shunt, one may develop hydrocephalus and increased intracranial pressure. Which totally fails the purpose of shunt placement.

  4. Infection at the Site of Shunt Placement - May spread to the cerebrospinal fluid and eventually affect the brain, which could turn fatal.


Shunting is one of the best methods to relieve the intracranial pressure on a long-term basis. Though it can be attached to the brain permanently, one has to go to the doctor for a regular check-up. Also, it may need repair or replacement if necessary. The doctor may educate the patient and their family on how to check if the shunt is working properly and how to care for it at home. A correctly operating shunt can effectively eliminate the complications from hydrocephalus.

Frequently Asked Questions


Is It Possible to Live Long With a Brain Shunt?

Brain shunts significantly help infants and adults in several conditions like hydrocephalus. Studies show that the ten-year survival rate is 60 to 70 %. An individual can lead an everyday life with regular monitoring of brain shunts every two years. The doctor may advise shunt replacement if necessary.


What Are the Uses of Brain Shunt?

Excess fluid build-up in the spaces or cavities within the brain results in hydrocephalus. It may exert pressure on the brain and cause headaches, seizures, and other abnormal symptoms. A brain shunt is also used in cases:
- Excess production of cerebrospinal fluid (CSF).
- Any hindrance to the pathway of CSF flow due to tumor and other conditions.


Does Shunt Cause Any Side Effects?

Brain shunts may cause various side effects due to infection or bleeding, and it includes:
- Fever.
- Headache.
- Vomiting.
- Fatigue.
- Sudden rise in blood pressure.


What Are the Indications for Brain Shunt?

A brain shunt is indicated in the following cases:
- Cerebrospinal fluid (CSF) overproduction.
- Improper absorption of excess CSF by blood vessels.
- Block in the CSF flow due to any tumor, etc.


Does Brain Shunt Cause Complications?

The possible complications of brain shunt are:
- Improper drainage by the shunt may raise the intracranial pressure.
- Infection due to shunt placement.
- Blockage in shunt pathway.
- Excess drainage of cerebrospinal fluid (CSF).


Is It Possible to Travel With a Brain Shunt?

The neuro specialist may advise not to do certain things after the placement of the brain shunt, such as:
- Strenuous exercise.
- Water sports.
- Gymnastics.
- Horse riding and other activities.
However, getting advice before traveling or flying with a brain shunt is better.


How Do I Know if a Shunt Is Malfunctioning?

The malfunctioning shunt may produce the following signs and symptoms:
- Vomiting.
- Intense headache.
- Sleepiness.
- Seizures.
- Irritability and confusion.
- Swelling at the site of shunt placement.


When Can a Person Recover From a Brain Shunt?

The placement of a brain shunt is considered a safe procedure. In addition, the doctor may give instructions after its posts. It includes avoiding strenuous physical exercise and other activities that may cause a head injury. Therefore, preventing such activities for about six weeks after shunt placement is better. But, the person can resume routine life within a week, and the recovery is quick.


Will the Shunt Stay Forever?

The shunt does not stay forever. After the brain shunt placement, regular follow-ups and monitoring are necessary. The shunt may get infected or malfunction after two years of placement in infants. Hence, shunt revision is essential after every two years. In adults, the shunts may stay longer, for eight years, but regular monitoring is required.


Can I Think of a Normal Life With a Shunt?

Studies show that the brain shunt has an 80 % of success rate. In addition, an individual can live an everyday life after shunt placement with:
- Regular monitoring.
- Follow-up with the neurosurgeon.
- Avoid activities that can cause a head injury.


Is Brain Shunt Surgery Serious?

Brain shut surgery is not considered a severe procedure. The specialist can safely place the shunt in the brain, and the recovery is quick. The success rate of the shunt is found to be 80 %. However, avoiding certain sports and activities that cause head trauma for six months is crucial. In a few cases, the brain shunt placement may lead to the following issues:
- Infection.
- Bleeding.
- Excess or inadequate drainage of cerebrospinal fluid (CSF).


Is Shunt Surgery Considered Brain Surgery?

Yes, shunt surgery is a brain surgery performed by a neuro specialist. It is a major surgery performed under general anesthesia. The whole procedure may take one to two hours, and the doctor may ask you to stay in the hospital for a day to monitor your health conditions and check for any abnormal signs. The specialist will also provide instructions to follow after shunt placement.


Is It Necessary to Check the Brain Shunt Many Times?

The brain shunt helps maintain the intracranial pressure by draining excess cerebrospinal fluid. The accumulated CSF is rerouted mostly to the abdomen, lungs, or heart, where it can be absorbed. However, there are possibilities of shunt malfunctioning, over or inadequate CSF drainage; therefore, monitoring or checking the brain shunt is essential in two years to prevent complications.

Last reviewed at:
18 Jan 2023  -  4 min read




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