Ventriculoperitoneal Shunt (VP Shunt)
Hydrocephalus, [communicating / obstructive / normal pressure]
Same
Right ventriculoperitoneal shunt placement
[***, MD/DO]
[Resident/Fellow/PA name]
General endotracheal
Patient presents with [communicating hydrocephalus / obstructive hydrocephalus / normal pressure hydrocephalus] with [ventriculomegaly on CT / clinical triad of dementia, gait instability, incontinence / increased ICP symptoms]. [Large-volume LP tap test positive.] Risks including shunt obstruction, infection, overdrainage, subdural hygroma, abdominal complications, and need for revision discussed. Consent obtained.
CT head demonstrated [moderate / severe] ventricular enlargement [with transependymal edema / without]. Target for frontal horn catheter placement identified. Peritoneal cavity accessible.
The patient was positioned supine with the head turned to the left and the right shoulder elevated. The right scalp, neck, chest, and right upper abdomen were prepped and draped in sterile fashion.
A right frontal burr hole was placed at Kocher's point (approximately 11 cm posterior to the nasion, 2.5-3 cm lateral to midline, 1 cm anterior to the coronal suture in the mid-pupillary line) using a high-speed drill. The dura was cauterized and opened sharply. A [medium pressure / programmable] [Medtronic Strata / Codman Hakim / Miethke proGAV / Sophysa Polaris] valve system was prepared and flushed with antibiotic-impregnated saline.
The ventricular catheter was passed [with / without] neuronavigation guidance toward the ipsilateral frontal horn at a depth of [6 cm]. CSF return confirmed ([clear / xanthochromic]). The catheter was secured to the valve at the burr hole.
The ventricular catheter was tunneled subcutaneously via a retroauricular relay incision to a small [right paramedian / right upper quadrant] abdominal incision. The peritoneum was entered under direct visualization. The peritoneal catheter was introduced into the peritoneal cavity and the distal end positioned in the right upper quadrant; free CSF flow from the peritoneal end confirmed; catheter secured with a purse-string suture.
All wounds were irrigated with antibiotic solution. Galea and skin closed in layers. Patient tolerated the procedure well.
None
CSF for cell count, protein, glucose, culture, and [cytology]
Minimal
VP shunt system in place
Patient taken to neurosurgical ICU/floor in stable condition.
Epic SmartPhrase Version
PREOPERATIVE DIAGNOSIS: Hydrocephalus, [communicating / obstructive / normal pressure]
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right ventriculoperitoneal shunt placement
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: General endotracheal
INDICATIONS: The patient is a .PTAGE-year-old .PTSEX with [communicating / obstructive / normal pressure] hydrocephalus and ventriculomegaly on CT. [Clinical triad of dementia, gait instability, and incontinence present. Large-volume LP tap test positive.] Risks including shunt obstruction, infection, overdrainage, subdural hygroma, abdominal complications, and need for revision were discussed. Informed consent obtained.
FINDINGS: CT head demonstrated [moderate / severe] ventricular enlargement [with transependymal edema]. Target for frontal horn catheter identified at Kocher's point. Peritoneal cavity accessible.
DESCRIPTION OF PROCEDURE:
Patient positioned supine with head turned left and right shoulder elevated. Right scalp, neck, chest, and right upper abdomen prepped in sterile fashion. Right frontal burr hole placed at Kocher's point (~11 cm posterior to nasion, 2.5-3 cm lateral to midline, 1 cm anterior to coronal suture) with high-speed drill. Dura cauterized and opened. A [medium pressure / programmable] [Medtronic Strata / Codman Hakim / Miethke proGAV / Sophysa Polaris] valve system prepared and flushed with antibiotic saline. Ventricular catheter passed [with / without] neuronavigation guidance toward ipsilateral frontal horn to *** cm depth. CSF return confirmed [clear / xanthochromic]. Catheter secured to valve at burr hole. Tunneled subcutaneously via retroauricular relay incision to small [right paramedian / right upper quadrant] abdominal incision. Peritoneum entered under direct visualization. Peritoneal catheter placed in right upper quadrant; free CSF flow confirmed; secured with purse-string suture. All wounds irrigated with antibiotic solution. Galea and skin closed in layers. Patient tolerated the procedure well.
ESTIMATED BLOOD LOSS: Minimal
SPECIMENS: CSF for cell count, protein, glucose, culture, and cytology
COMPLICATIONS: None
DRAINS: VP shunt system in place (valve setting: ***)
DISPOSITION: Patient taken to neurosurgical ICU/floor in stable condition.
Signed: .ME, .MYDEGREE
.TODAYVariants
Revision / proximal obstruction
Document which component was replaced and the CSF flow test result at each component prior to final assembly.
Endoscopic third ventriculostomy (ETV)
Alternative for obstructive hydrocephalus. Document endoscope entry, floor anatomy, stomal creation, and pulsatile flow confirmation.
Laparoscopic-assisted peritoneal catheter
For prior abdominal surgeries or obesity. Document laparoscopic visualization and catheter placement in right upper quadrant away from adhesions.
Charting Tips
- Document valve type, model, and pressure setting
- State Kocher's point or target used for ventricular catheter entry
- Note CSF characteristics and send for routine studies + culture
- Document catheter depth to first drainage hole
- If programmable valve: document make, model, and initial pressure setting. Programmable valves are MR-conditional (NOT contraindicated for MRI — generally safe up to 3T). After any MRI, verify valve settings using shunt series X-ray or manufacturer-specific device and reprogram if changed. Magnet-resistant valves (Miethke proGAV 2.0, Sophysa Polaris) typically maintain settings post-MRI. Document initial setting in the operative note.
- Peritoneal catheter length inserted into abdomen
Documentation & Reimbursement Considerations
- Report Ventriculoperitoneal Shunt (VP Shunt) as the primary service when it is the definitive operation performed.
- Some payers require multiple-procedure reporting on the secondary code. Document each component replaced or revised separately.
- 90-day global period: shunt series X-rays, programming adjustments, and neurologic checks are bundled.
- Do not use shunt codes when ETV is performed.