Analysis of factors affecting ventriculoperitoneal shunt survival in pediatric patients

Abstract

Management of hydrocephalus with insertion of ventriculoperitoneal (VP) shunt is associated with significant complications in both adult and pediatric patients. These may be more common in developing countries due to poor economic conditions and a dearth of available resources. We report a 6years' experience with VP shunt insertion in pediatric patients from a developing country, focusing particularly on factors affecting shunt failure. Patients aged below 15years, who had undergone insertion of VP shunts for hydrocephalus during the years 2006 to 2011, were included. A retrospective analysis of shunt survival was performed using Kaplan-Meier curves and Logrank (Cox-Mantel) test. Among the total 113 patients, the most common etiologies of hydrocephalus were congenital hydrocephalus (19.5%), brain tumors (14.2%), and postcranial surgery (13.3%). Overall shunt failure at a mean follow-up of 11months was 23% with the median time to first shunt failure being 68days. Shunt survival was worse in patients with meningitis (p = 0.024), aqueductal stenosis (p = 0.008), postcranial surgery hydrocephalus (p = 0.006), Caesarean mode of delivery (p = 0.036), congenital abnormalities (p = 0.031), and a past history of surgical excision of mass lesion (p = 0.044).Frequency of shunt failure was also significantly affected by the location of brain tumor (p = 0.015) and prematurity (p = 0.015). Premature infants still have a higher rate of shunt failure. Patients with meningitis, aqueductal stenosis, postcranial surgery hydrocephalus, congenital abnormalities, and a past history of surgical excision of mass lesion may have early shunt failure. However, the frequency of shunt failure that we observed (23%) was much lower than that quoted earlier in the literature and this may be a consequence of rigorous periodic evaluation of patients with VP shunt in situ.