A Retrospective Study on Ventriculoperitoneal Shunt Complications in a Tertiary Care Centre

Background Ventriculoperitoneal shunt (VPS) is a common technique employed to treat the second most common congenital brain malformation, “hydrocephalus.” Postshunt insertion, the consequent complications and factors contributing to shunt malfunction are much fought occurrences. The current study was planned to assess the effectiveness of the procedure, analyze the complications of VP shunt, and recognize the factors influencing shunt malfunction. Materials and Methods The present study was a retrospective observational study, which was conducted at the Department of Neurosurgery, PGIMER RML Hospital, New Delhi, from August 2016 to July 2018. Patients with hydrocephalus requiring shunt intervention were included in the study. A Chhabra “slit n spring” hydrocephalus shunt system was inserted in all patients. All patients with VP shunts were followed to assess for any postshunt complications. Results Out of 541 patients for whom VP shunt was inserted over a period of 2 years, 126 (23.3%) patients developed complications. The most common cause of hydrocephalus for which VP shunt was done was tubercular meningitis (39.3%, n = 63), followed by ventriculitis (12.38%, n = 20), congenital hydrocephalus (8.87%, n = 14) and aqueductal stenosis (5.54%, n = 03). The most common complication in our study was obstruction of proximal end of the catheter by debris, which was noted in 50 patients (39.68%). The second most common complication was poor peritoneal absorption or obstruction of lower end (21.43%, n = 27 cases). Abscess along the shunt was seen in 21 patients (16.67%). Complications were mostly documented in cases with hydrocephalus due to tubercular meningitis (TBM) (39.3%, 63 patients) and ventriculitis (12.38%, 20 patients). Other complications were hyperemia with superficial ulceration or complete exposure of skin overlying the tube (11.9%, n = 15), overdrainage of the ventricles leading to chronic subdural hematoma (n = 14, 11.11%), and infection around the distal catheter (4.76%, n = 6). Conclusion VPS procedure led to a complication in several patients, with the most common being obstruction of proximal catheter and poor peritoneal absorption or obstruction of lower end followed by abscess and infection.

Ventriculoperitoneal shunt complications in an adult population: A comparison of various shunt designs to prevent overdrainage

Background: Overdrainage after cerebrospinal fluid diversion remains a significant morbidity. The hydrostatic, gravitational force in the upright position can aggravate this. Siphon control (SC) mechanisms, as well as programmable and flow regulating devices, were developed to counteract this. However, limited studies have evaluated their safety and efficacy. In this study, direct comparisons of the complication rates between siphon control (SC) and non-SC (NSC), fixed versus programmable, and flow- versus pressure regulating valves are undertaken. Methods: A retrospective chart review was performed over all shunt implantations from January 2011 to December 2016 within the Houston Methodist Hospital system. Complication rates within 6 months of the operative date, including infection, subdural hematoma, malfunction, and any other shunt-related complication, were analyzed via Fisher’s exact test, with P < 0.05 regarded as significant. Subgroup analyses based on diagnoses – normal pressure hydrocephalus (HCP), pseudotumor cerebri, or other HCP – were also performed. Results: The overall shunt-related complication rate in this study was 19%. Overall rates of infection, shunt failure, and readmission within 180 days were 3%, 11%, and 34%, respectively. No difference was seen between SC and NSC groups in any complication rate overall or on subgroup analyses. When comparing fixed versus programmable and flow- versus pressure-regulating valves, the latter in each analysis had significantly lower malfunction and total complication rates. Conclusions: Programmable and pressure regulating devices may lead to lower shunt malfunction and total complication rates. Proper patient selection should guide valve choice. Future prospective studies may further elucidate the difference in complication rates between these various shunt designs.

The Neuroimaging Studies in Children with Ventriculoperitoneal Shunt Complications: A 10 Years Descriptive Study in Tehran

Background:Any mismatch between the production and absorption of CSF results in hydrocephalus. In most cases, the selected choice of treatment is the ventriculoperitoneal shunt insertion. Although, the surgery could have complications such as infection, shunt malfunction, subdural hematoma, seizure and Shunt immigration; so, the early and proper detection of these complications could result in better prognosis. The aim of this study was to evaluate and compare the efficacy of CT scan, CSF analysis and X-ray radiography in detection of shunt complications and problems in shunt placement and further follow-up in hospitalized children.Methods:The medical records of children in Rasul Akram hospital in Tehran were reviewed retrospectively in the last 10 years, from 2006 to 2016. All data were recorded in the prepared form including the age, sex, shunt complication, CT scan and CSF characteristics.Results:The total number of 95 patients were interfered in this study including 56 males (58.9%) and 39 females (41.1%). The mean age at the onset of complications were 2.8±2.2 years-old. The shunt obstruction (60%) and infection (25.3%) were the most common complications. The CT scan was able to detect 36.5% of shunt complications. The CT scan had the sensitivity and specificity of 50 and 87%, respectively in detection of shunt obstruction. The all cases of brain hematoma and hemorrhage were revealed by CT scan. On the other hand, the CT scan had 20% of sensitivity and 60% of specificity in the detection of shunt infection. The CSF evaluation in shunt infection revealed 92% hypoglycemia, 87.5% pleocytosis, and 62.5% positive CSF culture. CSF had the sensitivity, specificity, positive predictive value and negative predictive value of 92, 82, 63 and 97%, respectively. The patient's symptoms and signs were helpful in obtaining higher test accuracy.Conclusion:The CT scan was not a good sensitive and specific study in the detection of shunt obstruction and infection, but it was very accurate in detection of hemorrhage and hematoma. On the other hand, CSF evaluation was a reliable test in shunt infection disclosure.