A Prospective Study On Ventriculoperitoneal Shunt Surgery Complications In Tertiary Care Hospital

Abstract

Background and Aim: Hydrocephalus is defined as enlargement in ventricles size due to the increase in cerebrospinal fluid volume. Impaired cerebrospinal fluids in terms of absorption and pathways obstruction or subarachnoid spaces are the different causes for hydrocephalus. Ventriculoperitoneal shunt is the most prevalent performed treatment modality on elective or emergency basis for hydrocephalus in neurosurgery. However, this treatment modality is apprehended due to its various complications. There is paucity of data regarding ventriculoperitoneal shunt surgery complications. The present study aimed to evaluate the ventriculoperitoneal shunt complications in a tertiary care hospital.
 Methodology: This prospective study was conducted on 96 hydrocephalus patients who underwent ventriculoperitoneal shunt in the Department of Neurosurgery, Lady Reading Hospital, Peshawar from January 2020 to December 2021. Hospital research and ethical committee approved the study protocol and written informed consent was obtained from each patient. Hydrocephalus patients of either gender without age discrimination who underwent first ventriculoperitoneal shunts were enrolled. Patients who underwent external ventricular drain, lumboperitoneal shunts, shunts revision, and ventriculoatrial shunts were excluded. Detailed history, clinical inspections, and full investigations such as cerebrospinal fluid, C-reactive protein (CRP), X-rays examinations, full blood count (FBC), brain CT scans and abdomen pelvis ultrasound has been carried out in all eligible patients. Post-surgery routine follow-up was scheduled one and six months after discharge. SPSS version 25 was used for data analysis.
 Results: Of the total 96 hydrocephalus patients, there were 63 (66%) male and 33 (34%) females. Patient’s age-wise distribution was as follows: Age< 1 year 36 (37.5%), 1-10 years 28 (29.2%), 11-20 years 22 (22.9%), 21-30 years 7 (7.3%), and 31-40 years 3 (3.1%). The incidence of ventriculoperitoneal shunt surgery complications such as shunt blockage, infection, shunt erosion, and extrusion was 44 (45.8%), 34 (35.4%), 16 (16.7%), and 9 (9.4%) respectively. The mortality rate was 3.1% due to the complications of ventriculoperitoneal shunt surgery. Brain tumors was the most prevalent cause of hydrocephalus in 37 (38.5%) followed by Post-meningitis 21 (21.9%), encephaloceles 11 (11.5%), Cerebellar hematoma 10 (10.4%), Intraventricular hemorrhage 6 (6.3%), Aqueduct stenosis 4 (4.2%), Neurocysticercosis 2 (2.1%) and others 2 (2.1%). 
 Conclusion: Our study concluded that the most prevalent ventriculoperitoneal shunt surgery complications were shunt blockage and shunt infection. Brain tumors were the common cause of hydrocephalus followed by post-meningitis and encephaloceles. Shunt upper end is more susceptible to complications than the lower end. The overall mortality rate was 3.1%. These complications might leads to server clinical issues that results patient’s death.