Ventriculoperitoneal shunt complications in a developing country: a single institution experience

Abstract

Introduction: Shunting a hydrocephalus is among the most commonly performed neurosurgical procedures. Hydrocephalus constitute a significant medical problem in terms of urgency and treatment. Shunting of cerebrospinal fluid has dramatically reduced the morbidity and mortality of hydrocephalus, but they have potential complications that may need multiple surgical procedures during a patient's lifespan.

Materials and methods: We evaluated the following individual characteristics in relation to shunt complication rates: sex, ethnicity, age at the time of the first shunt placement (1 month [neonate], 1 to 12 months [infant], 1 to 18 years [child], 18 years [adult]), hydrocephalus type (spina bifida, congenital excluding spina bifida, communicating, obstructive) and socioeconomic status. In this retrospective study 193 patients were analyzed, unfortunately 27 where lost in the procedure of follow up and 12 died this patients were excluded from studies.

Results: Obstructive hydrocephalus (47.9%) was the most common diagnosis followed by communicating hydrocephalus (13.3%). Patients with ventriculoperitoneal shunt that were followed over time in 37% of cases experienced at least one surgical shunt complication during the study period and 13% of patients had multiple shunt complications.

Discussion: The causes for shunt malfunction include shunt infection, obstruction, distal catheter migration, shunt disconnection etc. Neonates and children experienced the highest complication rates. By 5 years of follow-up almost half of the children required a repeat surgical procedure. Children with obstructive hydrocephalus experienced the greatest risk of needing an initial shunt revision.

Conclusion: Ventriculoperitoneal shunts constitute a significant medical problem, in terms of both urgency of treatment and economic costs. In conclusion, young infants are at highest risk for CSF shunt revision.