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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2020; 9(03): 170-174
DOI: 10.1055/s-0040-1713562
Original Article

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

Pankaj Kumar
1   Department of Neuro Surgery, Atal Bihari Vajpyee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
,
Sharad Pandey   *
1   Department of Neuro Surgery, Atal Bihari Vajpyee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
,
Nitin Bhakal
1   Department of Neuro Surgery, Atal Bihari Vajpyee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
,
Sourabh Shrivastava
1   Department of Neuro Surgery, Atal Bihari Vajpyee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
,
L. N. Gupta
1   Department of Neuro Surgery, Atal Bihari Vajpyee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
,
Ravi Prakash Jha
2   Department of Community Medicine, Division of Biostatistics, Dr Baba Sahib Ambedkar Medical College, Delhi, India
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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.

Keywords

ventriculoperitoneal shunt - hydrocephalus - complications

* Previously with Department of Neuro Surgery, Sir Sunder Lal Hospital, IMS, BHU, Varanasi, Uttar Pradesh 221005, India.




Publication History

Article published online:
28 September 2020

© 2020. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Kandasamy J, Jenkinson MD, Mallucci CL. Contemporary management and recent advances in paediatric hydrocephalus. BMJ 2011; 343: d4191
    CrossrefPubMedGoogle Scholar
  • 2 Wu Y, Green NL, Wrensch MR, Zhao S, Gupta N. Ventriculoperitoneal shunt complications in California: 1990 to 2000. Neurosurgery 2007; 61 (03) 557-562
    CrossrefPubMedGoogle Scholar
  • 3 Chung JJ, Yu JS, Kim JH, Nam SJ, Kim MJ. Intraabdominal complications secondary to ventriculoperitoneal shunts: CT findings and review of the literature. Am J Roentgenol 2009; 193 (05) 1311-1317
    CrossrefPubMedGoogle Scholar
  • 4 Korinek AM, Fulla-Oller L, Boch AL, Golmard JL, Hadiji B, Puybasset L. Morbidity of ventricular cerebrospinal fluid shunt surgery in adults: an 8-year study. Neurosurgery 2011; 68 (04) 985-994
    CrossrefPubMedGoogle Scholar
  • 5 Puca A, Anile C, Maira G, Rossi G. Cerebrospinal fluid shunting for hydrocephalus in the adult: factors related to shunt revision. Neurosurgery 1991; 29 (06) 822-826
    CrossrefPubMedGoogle Scholar
  • 6 Khan F, Rehman A, Shamim MS, Bari ME. Factors affecting ventriculoperitoneal shunt survival in adult patients. Surg Neurol Int 2015; 6: 25
    CrossrefPubMedGoogle Scholar
  • 7 Reddy GK, Bollam P, Caldito G. Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg 2014; 81 (02) 404-410
    CrossrefPubMedGoogle Scholar
  • 8 Reddy GK. Ventriculoperitoneal shunt surgery and the incidence of shunt revision in adult patients with hemorrhage-related hydrocephalus. Clin Neurol Neurosurg 2012; 114 (09) 1211-1216
    CrossrefPubMedGoogle Scholar
  • 9 Reddy GK, Bollam P, Caldito G. Ventriculoperitoneal shunt surgery and the risk of shunt infection in patients with hydrocephalus: long-term single institution experience. World Neurosurg 2012; 78 (1-2) 155-163
    CrossrefPubMedGoogle Scholar
  • 10 O’Kelly CJ, Kulkarni AV, Austin PC, Urbach D, Wallace MC. Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage: incidence, predictors, and revision rates. Clinical article. J Neurosurg 2009; 111 (05) 1029-1035
    CrossrefPubMedGoogle Scholar
  • 11 Wu Y, Green NL, Wrensch MR, Zhao S, Gupta N. Ventriculoperitoneal shunt complications in California: 1990 to 2000. Neurosurgery 2007; 61 (03) 557-562, discussion 562–563
    CrossrefPubMedGoogle Scholar
  • 12 Bouras T, Sgouros S. Complications of endoscopic third ventriculostomy: a systematic review. Acta Neurochir Suppl (Wien) 2012; 113: 149-153
    CrossrefPubMedGoogle Scholar
  • 13 de Ribaupierre S, Rilliet B, Vernet O, Regli L, Villemure JG. Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: results from a Swiss series and literature review. Childs Nerv Syst 2007; 23 (05) 527-533
    CrossrefPubMedGoogle Scholar
  • 14 Ojo AO, Olumide E, Kanu OO. et al. Unusual complication of ventriculoperitoneal shunt. Romanian Neurosurg 2013; 24: 375-378
    CrossrefPubMedGoogle Scholar
  • 15 Hussain M, Raja RA, Shaikh AU, Ali MH. Ventriculoperitoneal shunt blockage. J Ayub Med Coll Abbottabad 2012; 24 (3-4) 82-84
    PubMedGoogle Scholar
  • 16 Shao Y, Li M, Sun JL. et al. A laparoscopic approach to ventriculoperitoneal shunt placement with a novel fixation method for distal shunt catheter in the treatment of hydrocephalus. Minim Invasive Neurosurg 2011; 54 (01) 44-47
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Reddy GK. Ventriculoperitoneal shunt surgery and the incidence of shunt revision in adult patients with hemorrhage-related hydrocephalus. Clin Neurol Neurosurg 2012; 114 (09) 1211-1216
    CrossrefPubMedGoogle Scholar
  • 18 Ammar A, Nasser M. A long-term complication of burying a shunt valve in the skull. Neurosurg Rev 1995; 18 (01) 65-67
    CrossrefPubMedGoogle Scholar
  • 19 Bot GM, Ismail NJ, Usman B. et al. Subpericranial shunt valve placement: a technique in patients with friable skin. Childs Nerv Syst 2014; 30 (08) 1431-1433
    CrossrefPubMedGoogle Scholar
  • 20 Peacock WJ, Currer TH. Hydrocephalus in childhood. A study of 440 cases. S Afr Med J 1984; 66 (09) 323-324
    PubMedGoogle Scholar
  • 21 Mwang’ombe NJ, Omulo T. Ventriculoperitoneal shunt surgery and shunt infections in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi. East Afr Med J 2000; 77 (07) 386-390
    PubMedGoogle Scholar
  • 22 Aldrich EF, Harmann P. Disconnection as a cause of ventriculoperitoneal shunt malfunction in multicomponent shunt systems. Pediatr Neurosurg 1990-1991–1991 16 (06) 309-311
    CrossrefPubMedGoogle Scholar
  • 23 Yung S, Chan TM. Pathophysiological changes to the peritoneal membrane during PD-related peritonitis: the role of mesothelial cells. Mediators Inflamm 2012; 2012: 484167
    CrossrefPubMedGoogle Scholar
  • 24 Sathyanarayana S, Wylen EL, Baskaya MK, Nanda A. Spontaneous bowel perforation after ventriculoperitoneal shunt surgery: case report and a review of 45 cases. Surg Neurol 2000; 54 (05) 388-396
    CrossrefPubMedGoogle Scholar
  • 25 Berry JG, Hall MA, Sharma V, Goumnerova L, Slonim AD, Shah SS. A multi-institutional, 5-year analysis of initial and multiple ventricular shunt revisions in children. Neurosurgery 2008; 62 (02) 445-453
    CrossrefPubMedGoogle Scholar
  • 26 Patwardhan RV, Nanda A. Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment. Neurosurgery 2005; 56 (01) 139-144
    CrossrefPubMedGoogle Scholar
  • 27 Tuli S, Drake J, Lawless J, Wigg M, Lamberti-Pasculli M. Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg 2000; 92 (01) 31-38
    CrossrefPubMedGoogle Scholar