CAUSES OF HYDROCEPHALUS AND COMPLICATIONS OF VP SHUNT IN PEDIATRIC POPULATION

Shahid Nawaz, Fakhar Hayat, Sarfaraz Khan, Sarah Rehman, Noor Sardar, Shehla Aman

Abstract


ABSTARCT
Background: Ventriculoperitoneal (VP) shunt is a common procedure for treatment of hydrocephalus. The objectives of the study were to determine the causes of hydrocephalus and complications of VP shunt in our pediatric population.
Materials & Methods: This descriptive, cross-sectional study was conducted in the Department of Neurosurgery, Gomal Medical College, D.I.Khan, Pakistan from January 2018 to January 2019. The sample size was 97 selected through consecutive, non-probability sampling technique using online sample size calculator, the Raosoft. The inclusion criteria were all pediatric patients with hydrocephalus. All those post-operative patient operated for other pathologies of brain and spine without VP shunt were excluded from the study. CT or MRI of brain with and without contrast were done. Post operatively all the patients were followed up till 6 months and any complication which occurred were documented. Demographic variable were sex and age in years. Research variables were causes of hydrocephalus and post-operative complications of VP shunt. All variables except age in years being categorical were analyzed through frequency and percentages. Age was calculated by mean and SD using SPSS version 20.
Results: Out of 97 patients, boys were 59(60.82%) and girls were 38(39.17%). The mean age of the sample was 4.5 ±5 ranging from 5 months to 13 years. The most common cause was aqueductal stenosis having 58(59.7 %), myelo-meningocele were 17(17.7%), post meningitis were 12(12.3%) and remaining 10(10.3%) were associated with brain tumors. Out of 21 patients 12(57.2%) developed shunt obstruction, 5(23.8%) shunt infection, 2(9.5%) developed post-operative seizures, 2(9.5%) had exteriorization of lower end of shunt through abdominal incision.
Conclusion: The most common cause of hydrocephalus is acqueductal stenosis. The most common complication of VP shunt is shunt obstruction in pediatric population, having pre-school boys as modal group.

Keywords


Complications; Ventriculoperitoneal shunt; Pediatric population; Shunt obstruction; Shunt infection.

Full Text:

PDF

References


Stein SC, Guo W. Have we made progress in preventing shunt failure? A critical analysis. J Neurosurg Pediatr 2008 Jan;1(1):40-7. doi: 10.3171/PED-08/01/040

Simpkins CJ. Pediatric Nursing. November-December 2005/Vol. 31

Schreffler RT, Schreffler AJ. Wittler RR. Treatment of cerebrospinal fluid shunt infections: a decision analysis. Pediatr Infect Dis J 2002 Jul; 21(7):632-6.

McGirt MJ, Wellons III JC, Nimjee S, Bulsara KR, Fuchs HE. George T.M. Comparison of total versus partial revision of initial ventriculoperitoneal shunt failures. Pediatr Neurosurg 2003; 38:34-40.

Jonathan J, Walker CT, Jacobson M, Phillips V, Silberstein HJ. Revision rate of pediatric ventriculoperitoneal shunts after 15 years. JNS 2013;11(1):15-9.

Kaufman BA, Mc Lone DG. Infection of cerebrospinal fluid shunts. In infection of the central nervous system. Scheld WM, Whitley RJ, Durack DT (Editors). Raven Press: New York; 1991. p. 561-85.

Morrice JJ, Young DG. Bacterial colonization of holter valves; a ten-year survey. Dev Med Child Neurol 1974;16:85-90.

Olsen L, Fryberg T. Complications in the treatment of hydrocephalus in children. Acta Pediatr Scand 1983;72:385-90.

Schoenbaum SC, Gardener P, Shillito J. Infections of the cerebrospinal fluid shunts: epidemiology, clinical manifestation and therapy. J Infect Dis 1975;131:543-52.

Sells CJ, Shurtleff DB, Loeser JD. Gram negative cerebrospinal fluid shunt-associated infections. Pediatr 1977;59:614-8.

Al-Tamimi YZ, Sinha P, Chumas PD, Crimmins D, Drake J, Kestle J, et al. Ventriculoperitoneal shunt 30-day failure rate: a retrospective international cohort study. Neurosurg. 2014;74:29–34.

Farahmand D, Hilmarsson H, Högfeldt M, Tisell M. Perioperative risk factors for short term shunt revisions in adult hydrocephalus patients. J Neurol Neurosurg Psychiatry. 2009;80:1248-53.

Reddy GK, Bollam P, Caldito G. Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg 2014;81:404-10.

Stein SC, Guo W. A mathematical model of survival in a newly inserted ventricular shunt. J Neurosurg 2007;107(6 Suppl):448-54.

Stone JJ, Walker CT, Jacobson M, Phillips V, Silberstein HJ. Revision rate of pediatric ventriculoperitoneal shunts after 15 years. J Neurosurg Pediatr 2013;11:15-9.

Raosoft® sample size calculator. Seattle, WA, USA: Raosoft Inc.; 2004. [cited 2017 Mar 20] Available at: http://www.raosoft.com/samplesize.html


Refbacks

  • There are currently no refbacks.


© 2011 Gomal Journal of Medical Sciences