Which combination of shunt types is used in children with spina bifida who have hydrocephalus?

• A. Ventriculoperitoneal (VP) shunt
• B. Ventriculoatrial (VA) shunt
• C. Ventriculoperitoneal shunt and Ventriculoatrial shunt
• D. No shunt is used

Answer: (C)

In hydrocephalus associated with spina bifida, CSF needs a way to drain away from the brain. A ventriculoperitoneal shunt is the usual first choice, sending CSF to the abdominal cavity. But in some children, peritoneal absorption can be unreliable due to prior surgeries, scarring, or infections, and a single pathway may not provide adequate drainage. Adding a ventriculoatrial shunt offers an alternate route, diverting CSF into the bloodstream via the heart. Using both types together creates redundancy and flexibility: if one route becomes blocked or poorly absorbed, the other can continue to drain CSF and maintain normal intracranial pressure. For these complex cases, employing both shunt types is a practical approach, which is why this combination is used.