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

Abstract

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.

Extrusion of the distal ventriculoperitoneal shunt catheter through the umbilicus: a systematic literature review from 1973 to 2021

“…Perforation of the hollow viscera, followed by the distal VPS catheter extrusion through the natural orifices, is one of the known complications of VPS insertion. 2,[4][5][6][7][34][35][36][37][38] Harischandra et al, in a comprehensive literature review for the VPS migration, and found that approximately 14% of the migration occurred through the abdominal wall. 9 They documented that majority of the migration was through the anterior abdominal wall.…”

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Diversion of the cerebrospinal fluid (CSF) from the ventricular system to the peritoneal cavity through the VPS catheter is one of the most frequently performed surgical procedures for treatment of hydrocephalus. [1][2][3] VPS insertion is associated with a wide variety of complications. The extrusion of the distal VPS catheter through the natural orifices is more common.

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Complicações Da Derivação Ventrículo-Peritoneal Em Pacientes Pediátricos: Uma Revisão Integrativa

“…Além disso, é possível mencionar outras complicações relacionadas à revisão do shunt, em decorrência da necessidade de múltiplos procedimentos cirúrgicos para a manutenção da DVP. Kumar et al, (2020) aponta que em neonatos, a fragilidade da pele pode levar à necrose do couro cabeludo devido à repetição dos shunts. Estudos indicam que até 20% dos pacientes podem apresentar bloqueio do shunt, e a taxa de infecção pode atingir 24,6% em crianças com hidrocefalia não tumoral.…”