Shunt insertion for hydrocephalus

An operation to put in a thin tube (a shunt) that drains excess fluid from the brain to another part of the body, relieving the pressure caused by hydrocephalus.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

A shunt is a thin tube that drains excess brain fluid to another part of the body, relieving the pressure caused by hydrocephalus.
It can greatly improve symptoms, but it is a long-term implant — shunts can block, become infected or stop working, and many people need revision operations over time.
For some people an endoscopic third ventriculostomy (ETV) is an alternative that avoids a permanent tube; which is better depends on the cause.
Knowing the warning signs of a shunt problem, and having an urgent route to the specialist team, is an essential part of having a shunt.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeBrain operation to drain fluid

AnaestheticGeneral anaesthetic

How long it takesOften around 1 to 2 hours

Hospital stayOften a few days

Time off workUsually a few weeks, depending on the cause and recovery

When you'll see resultsPressure symptoms often improve quite quickly; the shunt is a long-term device that needs monitoring

On the NHS?Almost always done on the NHS in a specialist neurosurgery centre

A general guide. Your surgeon will give you advice for your situation.

Best fit

Relieves the raised pressure in the head caused by hydrocephalus

Pause if

An endoscopic third ventriculostomy (ETV) would treat your type of hydrocephalus without a permanent tube.

Main recovery point

You are watched closely as the pressure settles. Headache and tiredness are common at first. The small wounds are checked. Most people stay a few days.

Good aftercare

Clear, written warning signs of a blocked or infected shunt, with an urgent contact route to the specialist team.

First few days (in hospital)

You are watched closely as the pressure settles. Headache and tiredness are common at first. The small wounds are...

First few weeks

The wounds heal and the tender line along the tube settles. Many pressure symptoms improve over this time...

Weeks to a few months

Energy returns gradually and you build up activity as advised. Any walking, memory or bladder problems may...

Ongoing (for life)

The shunt needs lifelong awareness and follow-up, because it can block, get infected or stop working over the...

Medical line illustration of neurosurgery brain procedure for Shunt insertion for hydrocephalus. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is shunt insertion for hydrocephalus?

Hydrocephalus is a build-up of cerebrospinal fluid (CSF) — the fluid that normally cushions the brain — inside the spaces (ventricles) of the brain. The extra fluid raises the pressure in the head, which can cause headaches, sickness, drowsiness, problems with walking, memory or bladder control, and, in babies, a growing head. A shunt is the most common treatment.

A shunt is a thin, soft tube with a valve. One end sits in a fluid space in the brain; the tube then runs under the skin to another part of the body, most often the tummy (a ventriculoperitoneal, or VP, shunt), where the extra fluid is absorbed. The valve controls how much fluid drains, to keep the pressure right.

For some people, an alternative operation called an endoscopic third ventriculostomy (ETV) is possible. This makes a small opening inside the brain to let trapped fluid escape and be absorbed, avoiding a permanent tube. Whether a shunt or an ETV is better depends on the type and cause of the hydrocephalus.

The most important thing to understand is that a shunt is usually a long-term implant rather than a one-off fix. It can greatly improve symptoms, but shunts can block, become infected or stop working over time, and many people need further operations during their life to revise them. Knowing the warning signs of a shunt problem is part of living with one.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Ventriculoperitoneal (VP) shunt

The most common type. The tube drains fluid from the brain to the tummy, where it is absorbed. A valve under the scalp controls the flow.

Other shunt routes

Less commonly, the tube drains to the heart (ventriculoatrial) or another space, when the tummy is not suitable. The principle is the same.

Adjustable (programmable) valve

Some shunts have a valve that can be reset from outside the body to fine-tune drainage. Strong magnets (including some scans) can affect certain valves, so the team checks the setting.

Endoscopic third ventriculostomy (ETV)

An alternative operation that makes a small opening inside the brain to let trapped fluid escape, avoiding a permanent tube. Suitable only for certain types of hydrocephalus.

Shunt versus endoscopic third ventriculostomy (ETV)

	Shunt	ETV
What it is	A permanent drainage tube	An internal opening, no tube
Suits	Most types of hydrocephalus	Certain blockage types only
Long-term device	Yes, with a valve	No implant left in
Main long-term issue	Blockage or infection	Opening can close over time
Decision	Made with a specialist team	Made with a specialist team

Whether a shunt or an ETV is better depends on the type and cause of the hydrocephalus and your situation. An ETV avoids a permanent implant but is only suitable for some people, and can stop working if the opening closes. A specialist team should explain which fits you.

Preparing for your surgery

Ask the team why a shunt (or an ETV) is recommended for your type of hydrocephalus, and what the alternatives are.
Expect brain scans before surgery, and sometimes pressure tests, to plan the operation.
Tell the team about all medicines, especially blood thinners, and any allergies.
If a programmable valve is planned, ask how it is set and what to do about scans (such as MRI) afterwards.
Arrange support at home and time off, usually a few weeks depending on the cause and your recovery.
Ask for clear, written warning signs of a shunt problem and the number to call.
Plan not to drive until your team confirms it is safe.

What happens

The operation is done under general anaesthetic, so you are asleep. The surgeon makes a small opening in the skull (a burr hole) and passes the top end of the shunt tube into a fluid space in the brain. The tube is then tunnelled under the skin, behind the ear and down the neck and chest, to the tummy (for a VP shunt), where the lower end is placed so the fluid can be absorbed.

A valve, usually felt as a small lump under the scalp, controls how much fluid drains. The small cuts are closed with dissolvable stitches or staples. The operation usually takes around one to two hours.

If an endoscopic third ventriculostomy (ETV) is done instead, the surgeon passes a small telescope through a burr hole and makes a tiny opening in the floor of a fluid space so the fluid can escape and be absorbed, without leaving a tube in place. Afterwards you are watched closely, and most people are in hospital for a few days.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

An endoscopic third ventriculostomy (ETV) would treat your type of hydrocephalus without a permanent tube.
There is an active infection that must be cleared before any implant is placed.
Your general health makes a general anaesthetic too risky, so the timing or approach is reconsidered.
The tummy or usual drainage site is unsuitable, so a different route or plan is needed.

Delay surgery if…

There is an active infection anywhere in the body, as a shunt should not be placed into infection where avoidable.
You are on blood thinners that need safe planning before surgery.
Further scans or pressure tests are needed to confirm the diagnosis and plan.
An ETV is being considered first, where suitable, to avoid a permanent implant.

Alternatives to discuss

Endoscopic third ventriculostomy (ETV) for certain types of hydrocephalus.
Treating the underlying cause (such as a tumour or blockage) where that resolves the problem.
A different drainage route (for example to the heart) if the tummy is unsuitable.
Close monitoring in selected mild or uncertain cases, under specialist guidance.
A second specialist opinion before committing to a shunt.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

General anaesthetic

Shunt insertion and ETV are done fully asleep under a general anaesthetic.

Benefits

Relieves the raised pressure in the head caused by hydrocephalus
Often improves symptoms such as headache, sickness, drowsiness, walking, memory or bladder problems
Can be life-saving when pressure is dangerously high
In babies, helps protect brain development by controlling head growth and pressure
An ETV, where suitable, can treat the problem without leaving a permanent implant

Risks & complications

More common

Headache and tiredness in the early period as the pressure settles
A small lump under the scalp where the valve sits, and a tender line under the skin along the tube
Bruising and swelling around the small wounds

Less common

The shunt blocking or stopping working, so symptoms of raised pressure return
Infection of the shunt, often in the first weeks, sometimes needing the shunt to be removed and replaced
Over-drainage, causing low-pressure headaches that are worse when sitting or standing
Seizures (fits)

Rare but serious

Bleeding inside the head around the tube
The tube moving or causing a problem where it ends (for example in the tummy)
Serious complications that can be life-threatening; death is uncommon but possible

The biggest thing to understand is that a shunt is a long-term device that can block, become infected or stop working, and many people need one or more revision operations over their life. Infection is most likely in the first weeks. Learn the warning signs of a shunt problem and keep an urgent route to your specialist team, because a blocked or infected shunt needs prompt assessment.

Published figures to discuss

Risks depend on the cause of the hydrocephalus, your age and general health, and whether it is a first shunt or a revision. The most important long-term issues are infection and the shunt blocking or failing, leading to revision surgery. The figures below come from research and are a guide to the scale of risk only; they vary widely between groups (for example babies versus adults) and centres, so your team should give you figures for your situation.

Figure	Reported range	How to interpret it	Source / confidence
Shunt infection	Commonly around 5–8%; some adult series report nearer 3–4%, and some paediatric/high-risk groups higher	Most likely in the first weeks; may mean the shunt has to be removed and replaced. Higher in some groups, such as very young babies.	VP shunt complications and revision rates — analysis (PMC)pmc.ncbi.nlm.nih.govPublished figure
Needing a revision (shunt failure over time)	High: one international cohort reported about 13% failure by 30 days and 29% by 1 year for new shunts; revision shunts failed more often	Varies greatly by cause and age; children often need revisions as they grow.	VP shunt complications and revision rates — analysis (PMC)pmc.ncbi.nlm.nih.govPublished figure
Shunt blockage or over-drainage symptoms	Common reasons for later shunt review	Headache, vomiting, drowsiness, visual change, behaviour change or worsening walking can signal malfunction.	VP shunt complications and revision rates — analysis (PMC)pmc.ncbi.nlm.nih.govSource-linked context
Lifelong shunt dependency and emergency presentations	Common after shunt treatment	Patients and families need written red flags and rapid access pathways because malfunction can occur years later.	Guide sourcesClinical context

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery from the operation itself is usually fairly quick, and pressure symptoms often improve within days. The longer-term task is living with a shunt: knowing the warning signs of a problem and attending follow-up, because shunts need monitoring for the rest of your life.

First few days (in hospital)

You are watched closely as the pressure settles. Headache and tiredness are common at first. The small wounds are checked. Most people stay a few days.

First few weeks

The wounds heal and the tender line along the tube settles. Many pressure symptoms improve over this time. Infection, if it happens, is most likely in this early period, so warning signs matter.

Weeks to a few months

Energy returns gradually and you build up activity as advised. Any walking, memory or bladder problems may continue to improve, depending on the cause. A follow-up scan may check the fluid spaces.

Ongoing (for life)

The shunt needs lifelong awareness and follow-up, because it can block, get infected or stop working over the years. You learn the warning signs and keep details of your shunt and valve setting to hand.

What's normal — and not a worry

Headache and tiredness in the early period as the pressure settles
A small lump under the scalp where the valve sits
A tender line under the skin along the path of the tube for a while
Gradual improvement in pressure symptoms over days to weeks

Aftercare

Follow wound-care advice and keep the small wounds clean and dry.
Learn the warning signs of a shunt problem and keep the specialist team's number to hand.
If you have a programmable valve, carry its details and tell anyone arranging a scan (such as MRI), as some scans can change the setting.
Take any medicines, including anti-seizure medicines if prescribed, exactly as directed.
Build up activity gradually as advised, and avoid heavy lifting at first.
Do not drive until your team confirms it is safe.
Attend all follow-up appointments and scans, as shunts need lifelong monitoring.

Before-surgery checklist

Written warning signs of a shunt problem and an emergency contact number
Details of your shunt type and valve setting kept safe (for example a shunt card)
Any medicines, including anti-seizure medicines, collected and understood
Someone to help at home in the early days
Transport sorted, knowing you may not be able to drive at first
Follow-up scan and clinic appointments noted
A note to mention your shunt before any future scan or operation

Scars and how they heal

Shunt surgery leaves small scars: one on the scalp (usually hidden in the hairline) where the valve and brain end sit, and one on the tummy (or chest) where the tube ends. There is often a small lump under the scalp where the valve is, and you may feel the tube as a tender line under the skin for a while. Scars usually fade over months.

⚠ Get urgent help if…

A return of pressure symptoms: a worsening headache, sickness, drowsiness or confusion (possible shunt blockage)
Redness, swelling, heat or tenderness along the shunt line or wounds, or a high temperature (possible shunt infection)
In babies and children: a bulging soft spot, a rapidly growing head, irritability, poor feeding or sleepiness
New or worsening problems with walking, vision or balance
A seizure (fit)
A headache that is much worse when sitting or standing and better lying down (possible over-drainage)
Tummy pain, redness or swelling where the tube ends

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result means the raised pressure is relieved and symptoms such as headache, sickness, drowsiness, walking, memory or bladder problems improve. How much improves, and how quickly, depends on the cause of the hydrocephalus and how long symptoms were present. In babies, controlling the pressure helps protect development.

A shunt does not cure the underlying reason for the hydrocephalus, and it cannot guarantee that every symptom will resolve or that it will work without problems forever. Because it is a long-term device, it needs monitoring, and some symptoms may improve only partly. The realistic goal is set with your specialist team and depends on your situation.

How long it lasts

A shunt is designed to stay in place long term, but it is a mechanical device that can block, become infected or stop working, so many people need one or more revision operations during their life. Children often need revisions as they grow. An ETV, where used, avoids an implant but can stop working if the opening closes. Your team will explain how you will be followed up and what to do if the shunt fails.

Combining with other procedures

Shunt surgery treats the build-up of fluid, but the underlying cause of the hydrocephalus (such as a bleed, infection, tumour or a problem present from birth) may need its own treatment and monitoring. Care is usually managed by a specialist neurosurgery team, sometimes alongside other specialists depending on the cause.

Follow-up & long-term care

You will be followed up by your neurosurgery team, often with scans to check the fluid spaces and reviews of your symptoms, and you keep details of your shunt and valve setting. Follow-up continues long term because a shunt needs lifelong monitoring. Any warning signs of a blocked or infected shunt — returning headache, sickness, drowsiness, fever or redness along the tube — should prompt urgent contact rather than waiting.

Keep details of your shunt type and valve setting safe, and mention them before any scan or operation.
Attend follow-up appointments and scans, as shunts need lifelong monitoring.
Learn and act on the warning signs of a blocked or infected shunt.
Take any anti-seizure or other medicines exactly as prescribed.
Tell anyone arranging an MRI about a programmable valve, as it may need rechecking afterwards.

Revision and secondary surgery reality

Many people need one or more revision operations over their life, as shunts can block, become infected or stop working.
Children often need revisions as they grow and the tube needs lengthening.
An infected shunt usually has to be removed, the infection treated, and a new shunt placed later.
Over-drainage or under-drainage may need the valve adjusting or changing.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

Clear, written warning signs of a blocked or infected shunt, with an urgent contact route to the specialist team.
A record of the shunt type and valve setting (such as a shunt card), and advice to mention it before any scan or operation.
Lifelong follow-up with scans and symptom review, and a clear plan if the shunt fails.
Advice on programmable valves and MRI/magnet precautions.
Coordinated care for the underlying cause of the hydrocephalus, with support for you and your family.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

Shunt surgery is overwhelmingly an NHS service, so private cost questions arise rarely
Where private care applies: the neurosurgeon's and anaesthetist's fees
The type of shunt and valve used (for example an adjustable valve)
Hospital stay, including any high-dependency care
Imaging before and after surgery
Long-term follow-up and the possibility of revision operations
Treatment of the underlying cause of the hydrocephalus, where needed

Make sure your written quote includes

The named neurosurgeon's fee and the anaesthetist's fee
The hospital fee, including any high-dependency stay
The shunt and valve used, and imaging costs
Follow-up scans and reviews included
What happens, and who pays, if the shunt blocks, becomes infected or needs revision
How treatment of the underlying cause would be arranged and funded
Cancellation and rescheduling terms

On the NHS? Shunt insertion for hydrocephalus is almost always carried out on the NHS in specialist neurosurgery centres; private care is uncommon, though people may seek a private second opinion.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Choosing a surgeon safely

Check your surgeon is on the GMC Specialist Register for this area.
Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good surgeon will welcome every one of these.

Why is a shunt (rather than an ETV) recommended for my type of hydrocephalus?
What are the warning signs of a shunt problem, and who do I contact urgently?
Will my valve be programmable, and what do I do about future MRI scans?
How likely am I to need a revision operation, and what would that involve?
Which of my symptoms are likely to improve, and how soon?
How will I be followed up, and what details of my shunt should I keep?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the surgeon who carries out my operation, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this operation not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

How long does a shunt last?

A shunt is meant to stay in long term, but it is a mechanical device that can block, become infected or stop working, so many people need revision operations over their life. Children often need revisions as they grow. There is no guaranteed lifespan, which is why follow-up matters.

How will I know if my shunt is not working?

Warning signs include the return of pressure symptoms — a worsening headache, sickness, drowsiness or confusion — or signs of infection such as redness along the tube, fever or feeling unwell. In babies, watch for a bulging soft spot, a fast-growing head or sleepiness. Contact your team urgently if these happen.

Is it done on the NHS or privately?

Shunt surgery is almost always carried out on the NHS in specialist neurosurgery centres. Private care is uncommon; people sometimes seek a private second opinion about their diagnosis or options.

Can I have an MRI scan with a shunt?

Usually yes, but if you have a programmable (adjustable) valve, a scan can sometimes change its setting, so the team checks and resets it afterwards if needed. Always tell anyone arranging a scan that you have a shunt and what type.

What is an ETV, and is it better than a shunt?

An endoscopic third ventriculostomy makes a small opening inside the brain to let fluid escape, avoiding a permanent tube. It suits only certain types of hydrocephalus and can stop working if the opening closes. Whether it is an option for you depends on the cause; your team will advise.

Will the shunt cure my hydrocephalus?

A shunt controls the build-up of fluid and usually improves symptoms, but it does not cure the underlying cause and is a long-term device that needs monitoring. Some symptoms may improve only partly, depending on the cause and how long they were present.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Hydrocephalus: treatment NHS — Hydrocephalus Brain & Spine Foundation — Hydrocephalus Shine (Spina bifida and Hydrocephalus) — Hydrocephalus information Ventriculoperitoneal shunt infection rates — review (PMC) VP shunt complications and revision rates — analysis (PMC) Ventriculoperitoneal shunt 30-day and 1-year failure rates — international cohort

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.