Ventriculo-Peritoneal Shunt Complications at Emergency Teaching Hospital in Duhok City

Background: Ventriculoperitoneal (VP) shunt surgery is the predominant mode of therapy for patients with hydrocephalus. However, it has potential complications that may require multiple surgical procedures during a patient’s lifetime. The aim of the article was to review the experience in a 2-year teaching hospital and to evaluate the risk factors for PV shunt failure after initial shunt surgery and after subsequent reviews.

Methods: The study was carried out at The Emergency Teaching Hospital in Duhok City in Iraq. All complications of VP shunted patients admitted to the hospital from January 2013 to January 2015, were included in the study. Forty six patients (out of 170 VP shunt operations), with all shunt related complications, qualified for this study. Identification of patients with complications of VP shunt is done by obtaining proper history, examination, and identification of ventricular enlargement with periventricular edema on imaging (brain computed tomography (CT) or magnetic resonance study (MRI); also, identification of any evidence of device migration by direct vision, chest and abdominal X-ray and evidence of infection on CSF analysis.

Results: The incidence of the complications was (27.1%). There were 24 (52.2%) males and 22 (47.8%) females. Males were affected more than females with a ratio 1.1:1. Their age ranged from 2 months to 67 years, with mean age 8.6 years. The most common cause for the initial VP shunt implantation was congenital hydrocephalus and was noticed in 34 (73.9%) patients. Mean duration to develop VP shunt complication was 26.6 months. The most common presenting symptom in pediatric patients was decreased oral intake in 37 (80.4%) patients; however, in adult patients, it was headache, 4 (80%) patients. The most common complication was obstruction, 25 (54.3%) patients, followed by infection in 9 (19.6%) patients. The most common treatment option given to the patients who suffered from VP shunt complications was whole system change for a new one, in 15 (32.6%) patients.

Conclusions: The findings of the study indicate that age of the patient at time of shunt placement, etiology of hydrocephalus, and previous treatments before shunt surgery were independently significantly associated with the shunt survival. Prospective controlled studies are required to address the observed associations between the risk factors and incidence of shunt revisions in these patients.