Study of Relationship between Location of Ventricular Catheter Tip and Function of the Ventriculoperitoneal (VP) Shunt in Hydrocephalus in Children

Abstract

Objective: To determine the relationship between location of the ventricular catheter tip and functional status of the ventriculo-peritoneal (VP) shunt in children. Methods: This prospective observational study was conducted in Faculty of Paediatric Surgery under the Department of Paediatric Neurosurgery in Bangladesh Shishu Hospital and Institute (BSH&I) from January 2017 to December 2021. The study included 140 patients who underwent ventriculo-peritoneal shunt using free hand technique. Data obtained for each patient included age, sex, diagnosis including site and side of ventricular catheter placement. Postoperative CT scan of brain were done in all cases and followed up over 2½ to 4½ years. Sixty-three patients were available for follow up. The relationship of location of ventricular catheter tip and function of the ventriculo-peritoneal shunt was analyzed in all 63 patients. Results: Number of the patients included in the study was 140. Accuracy of ventricular catheter tip placement were 55(39.28%) using freehand technique. VP shunts function well in 43(68.25%) patients. Among the 43 patients with well-functioning shunts, 19 were in accurate group, 7 were in suboptimal group and 17 were in inaccurate group. Twenty-six (41.27%) patients had good outcome with normal development. Conclusion: Mechanical malfunction and infection are the most significant problems associated with VP shunts for the treatment of hydrocephalus. A significant proportion of shunt failure is due to inaccurate placement of the ventricular catheter tip. Accurate placement of the catheter tip is highly important to reduce the incidence of shunt malfunction.