Ventriculoperitoneal shunt complications: A review (original) (raw)
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Early Complications of Ventriculoperitoneal Shunt in Pediatric Patients With Hydrocephalus
Cureus, 2021
Ventriculoperitoneal shunt (VPS) is the most commonly used procedure for the treatment of hydrocephalus (HDC), especially in children. However, this is prone to many complications, and requires repeated surgeries, which as such increases the morbidity of the patients. It is estimated that majority of the complications occurs in the immediate post-operative period and the rate of complications decreases over the time, with no impunity to these, though. We conducted this study to know about the complications of VPS in the early post-operative period, in pediatric patients with hydrocephalus.
Cureus
Ever since the shunt device became the gold standard treatment for hydrocephalus, complications due to infections and mechanical problems have increased while lives have been saved. In addition, abdominal complications have become an important issue as the peritoneum is now the main place to insert the distal catheter. The most common complications were abdominal pseudocyst, distal catheter migration, inguinal hernia, catheter disconnection, and intestinal obstruction. The pediatric population is more prone to develop most of these complications due to their rapidly growing body, weaker abdominal musculature, and increased intraabdominal pressure. The goal of this review was to study the main aspects associated with abdominal complications after ventriculoperitoneal shunt (VPS) insertion, including the pathophysiology, epidemiological aspects, as well as the rationale for management and prevention according to the current "state-of-the-art." It is paramount to recognize the risk factors associated with various types of complications to manage them properly.
Hydrocephalus with Ventriculoperitoneal Shunts in Infants: Our Experiences and Clinical Outcomes
Journal of Morphological Sciences
Hydrocephalus is a condition resulting from disorder in absorption and circulation of the cerebrospinal fluid (CSF). It leads to a progressive ventricular dilatation and need of ventriculoperitoneal shunt (VP) placement. The aim of our study was to present our experience with infants with hydrocephalus, ventriculoperitoneal shunt placement, and early postoperative follow-up. A retrospective study was conducted comprising infants with hydrocephalus born between January 2019-January 2022 with ventriculoperitoneal shunt placement performed at the University Clinic for Neurosurgery in Skopje, Macedonia. Demographic and clinical characteristics, complications and the need for ventriculoperitoneal shunt were documented. Of twenty-three infants with hydrocephalus, 14 (60.8%) were preterm infants (median birth weight 2120 g; mean gestational age 33.1 weeks), 9 (39.1%) were term infants (mean birth weight 3600 g; mean gestational age 38.4 weeks). The etiology of hydrocephalus was: congenital hydrocephalus in 5 infants (21.7%), prematurity in 6 infants (26.08%), spina bifida in 2 infants (8.7%), systemic infection in 4 infants (17.3%), and intraventricular hemorrhage in 6 infants (26.08%). Ventriculoperitoneal shunt was placed in all 23 infants, at the mean age of 33.5 (30-43) days. Postoperative complications as a result of ventriculoperitoneal shunt placement were: ventriculitis manifested in 3 preterm (13%) infants, of which 2 (8.6%) died; five term infants (21.7%) had postoperative seizures, of which 2 infants (8.6%) died. Nineteen infants (82.6%) were discharged and transferred to the neonatology department. Ventriculoperitoneal shunt placement is a treatment of choice for infants with hydrocephalus, although postoperative complications in preterm infants increase the percentage of morbidity and mortality.
Child's Nervous System, 2016
Object Ventriculoperitoneal (VP) shunts in infants with posthemorrhagic hydrocephalus (PHH) are prone to failures, with some patients at risk for multiple revisions. The objective of our study is to observe long-term outcomes and identify factors leading to proximal and distal multiple failures. Methods We performed a retrospective review of infants with PHH that required VP shunt placement between 1982 and 2014. These patients were monitored clinically and radiographically after VP shunt placement. Results A total of 502 surgical procedures (initial shunt insertion and revisions) were performed, with 380 shunt revisions in 102 (84 %) patients. Median shunt survival time was 54 months (0.03-220 months). Shunt survival was significantly affected by the following factors: intraventricular hemorrhage (IVH, grade II-III, 95 months vs. grade IV, 28 months, p = 0.022), birth weight (<1.5 kg, 59 months vs. >1.5 kg, 22 months, p = 0.005), gestational age (>27 weeks, 90 months vs. <27 weeks, 20 months, p < 0.0001), distal vs. proximal revision (133 months vs. 48 months, p = 0.013), obstruction (yes, 78 months vs. no, 28 months, p = 0.007), and infection (no, 75 months vs. yes, 39 months, p = 0.045). Regression analysis revealed that multiple gestation, head circumference (>27 cm), congenital anomalies, infection, and obstruction increased the proximal and distal shunt malfunction. Conclusion Long-term outcome of VP shunt placement in infants revealed a relatively high rate of complications requiring shunt revision as late as 30 years after initial placement. Infants with VP shunts should be monitored lifelong of these patients by neurosurgeons.
JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA
Background: Cerebrospinal fluid shunting is the most commonly performed surgical procedure in the management of hydrocephalus. Although frequently performed, this procedure is not free of complications. Case description: We report a case of non-described shunt migration, in which the ventricle-peritoneal catheter, at the mediastinum level, crosses to the contralateral side. Conclusion: When we are faced with complications after ventriculoperitoneal shunt surgeries, we should consider unusual or even unpredictable possibilities.
COMPLICATIONS OF VENTRICULOPERITONEAL SHUNTS IN BENIN CITY, NIGERIA
Annals of Biomedical Sciences, 2019
Background: In most neurosurgical centres, ventriculoperitoneal shunt (VPS) is a commonly performed neurosurgical procedure for cerebrospinal fluid (CSF) diversion in Hydrocephalus in children, especially, but also in adults though etiology may differ. Despite the advent of other CSF diversionary procedures, like endoscopic third ventriculostomy, VPS has remained the mainstay of the treatment for Hydrocephalus. However, it is fraught with several complications.
Hydrocephalus and Ventriculoperitoneal Shunts: Modes of Failure and Opportunities for Improvement
Critical Reviews in Biomedical Engineering, 2016
Between 0.5 and 4 of every 1000 children are born with hydrocephalus. Hydrocephalus is an over-accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain, which can affect cognitive function, vision, appetite, and cranial nerve function. Left untreated, hydrocephalus can result in death. The current treatment for hydrocephalus uses ventriculoperitoneal (VP) shunts with valves to redirect CSF from the ventricles into the peritoneum. Shunt technology is limited by a number of complications, which include infection after implantation, shunt obstruction due to clot formation or catheter obstruction by scar tissue or choroid plexus, disconnection and tubing migration, and overdrainage or underdrainage of CSF due to valve malfunction. While modifications to surgical procedures and shunt design have been introduced, only modest improvements in outcomes have been observed. Here we provide an overview of hydrocephalus, VP shunts, and their modes of failure, and we identify numerous areas of opportunity for biomedical engineers and physicians to collaborate to improve the performance of VP shunts.
Egyptian Journal of Neurosurgery
Background Ventriculoperitoneal shunt is one of the most popular cerebrospinal fluid diversion procedures worldwide. Complications are common, but uncommon complications are rarely reported in the literature making a standardized guideline on management of unusual complications unavailable. We report this series of uncommon complications managed in our centre to share our experience and contribute to the pool of literature on the management of these weird complications of ventriculoperitoneal shunting. Case presentation The first case was a 10-year-old girl who presented with headache, early morning vomiting and itching over the tract of the shunt in the neck. She has had ventriculoperitoneal shunt and excision and repair of encephalocele at the age of 3 months in our facility. On physical examination, she was conscious with a Glasgow coma score of 15, and shunt valve was hardened. She had removal of the shunt with intraoperative finding of calcified shunt tubing and the valve, and ...
Indian Journal of Neurosurgery
Background Ventriculoperitoneal (VP) shunt insertion is routinely performed for the treatment of hydrocephalus due to different indications like congenital, infective, tumor, posttraumatic, and normal pressure hydrocephalus (NPH). A lot of common and rare complications following this procedure have been reported. Objectives To analyze the clinical profile, indications, anesthetic, and postoperative complications for VP shunt surgery in our center. Materials and Methods This prospective clinical review study was conducted in the Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, between October 2018 to January 2020 and included 454 cases of hydrocephalus who underwent VP shunt surgery. The data was compiled and analyzed. Results A total of 454 patients with male predominance were studied. Pediatric and adolescent patients were 48.9% (222/454). Obstructive hydrocephalus due to tumors was the etiology of 48.7% (221/454) cases. The incidence o...
Management of Postoperative Ventriculoperitoneal Shunt Complications in Pediatric Patients
The Egyptian Journal of Hospital Medicine, 2019
Background: Postoperative ventriculoperitoneal (VP) shunt complications in pediatric patients involves impaired absorption of CSF from the subarachnoid space to the venous circulation via the arachnoid villi. It also involves obstruction in flow of CSF from the ventricles to the subarachnoid space. Objective: To assess the proper management of postoperative shunt complications. Patients and Methods: Retrospective study conducted in the Neurosurgery Department of Al-Azhar University Hospitals and El-Sahel Teaching Hospital. Pediatric patients from both genders including infants and pediatric patients till 12 years old who were having postoperative ventriculoperitoneal shunt complications were assessed clinically and radiographically for the best management that include either surgical or medical ones or both .Results: The management of postoperative VP shunt malfunction is essential shunt revision of either proximal or distal catheters or the whole system if shunt disintegration is suspected. The most common organisms in shunt infection were gram positive organisms (coagulase negative staph. and staph. aureus). Conclusion: The most effective management plan is shunt revision. To prevent VP shunt malfunction, we have to make sure of intraoperative closed, sterile and functioning shunt system.