Complication Of Ventriculoperitoneal Shunt Surgery Research Articles

Subcutaneous emphysema and pneumocephalus following Ventriculoperitoneal Shunt (VPS) surgery for hydrocephalus: a case report

Link Video Abstract: https://youtu.be/vfAwOXSjbCE Background: Hydrocephalus is still commonly found in pediatric neurosurgery managed by endoscopic third ventriculostomy (ETV) and Ventriculoperitoneal Shunt (VPS). Subcutaneous emphysema and pneumocephalus as a complication of VPS surgery is rare. Subcutaneous emphysema is the presence of air in the skin, while pneumocephalus is the presence of air in the intracranial space. This case study aims to evaluate subcutaneous emphysema and pneumocephalus following ventriculoperitoneal shunt surgery for hydrocephalus. Case Presentation: We report an 11-month-old girl with hydrocephalus due to aqueductal stenosis who postoperatively had subcutaneous emphysema and pneumocephalus. 1 week after VPS insertion, there was a crepitation under the skin of the neck and chest. The patient occasionally appeared breathless and had a fever. The respiratory rate increased with rales on the right lung, along with the gradually decreased consciousness, and the abdominal wound slowly became dehiscent. There was subcutaneous emphysema along the shunt track and pneumocephalus. Conclusion: The interest, in this case, could be that of the patient’s other morbid conditions, including pneumonia and the dehiscent abdominal wound on the post-VP shunt insertion incision that may have also contributed to causing the subcutaneous emphysema and pneumocephalus.

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

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.

A Descriptive Study on Complications of Ventriculoperitoneal Shunt Surgery in Nangarhar Regional Hospital 25/Mar/2018 – 16/Mar/2019

Ventriculoperitoneal shunt treats hydrocephalus by altering CSF flow within the brain. In most of the cases, shunts consist of three parts, which are serially connected to each other: the proximal catheter, one-way valve and distal catheter. Ventriculoperitoneal shunt is one of the most commonly performed neurosurgical procedure, both on the elective and emergency basis. Consequently, in this paper, the indications for shunt, the types used, cure, and complications of ventriculoperitoneal shunts were studied. During this “Quantitative “, with amalgamating with case series study out of 109 VP-stunted patients, 38 were show up with complication. The shunt complication diagnosis is initially suspected according to the history and physical examination and high intracranial pressure. The purpose of this study is to determine VP-shunt complication, incidence of VP shunt complication in different age of childhood life and geographic findings of complication.
 20 patients which is 52.6% of study is male patient, from 2 months to 2 years were 30 patients which (78.3%) of study, 26 complicated patients which is (68.4%) from Nangarhar province. During this study we found 8 patients (21.1%) with abdominal pseudo cyst, 3 patients (7.9%) with skin irritation, 2 patients with (5.3%) fever, 8 patients (21.1%) with shunt upper end and reserve infection, 6 patients (15.8%) with shunt lower end infection, 2 patients (5.3%) with disconnected shunt, 8 patients (21.1%) shunt tube lower end obstruction and 1 patient (2.6) with VP Shunt extrusion from month (real complication).

Unusual Complications of Ventriculoperitoneal Shunt Surgery

Background: Ventriculoperitoneal shunt (VP shunt) surgery is one of the most common procedures being performed in the pediatric age group in neurosurgical centers worldwide. Although considered a simple surgery, the complications have made it one of the most difficult procedures to manage in the long term. In this study, we describe our experiences in managing the unusual complications of this common procedure in children. Materials and Methods: This retrospective study enrolled 13 pediatric cases having unusual complications related to VP shunt who presented to us from August 2013 to August 2019. All the cases were evaluated for their demographic profile, type of complications, possible pathophysiology, outcome, and management. We had used only spring-valve-based Chhabra VP shunt in all of our cases. Results: The age group ranged between 2 and 18 years, with a male to female ratio of 9:4. Anal extrusion of distal shunt tube was observed in four cases, and two cases each of urethral and oral extrusion were also seen. Two cases developed extrusion of shunt tube through the anterior abdominal wall and one case developed umbilical fistula. Multiple extradural hematoma and intraventricular bleed with partial shunt coil were also seen in each of the cases, respectively. All cases were managed as per need. Conclusion: Unusual complications of VP shunt surgery are increasingly being observed nowadays. Prompt diagnosis and treatment of these complications result in an excellent outcome.

Uncommon complications of ventriculoperitoneal shunt surgery: review of four cases and literature review

BackgroundVentriculoperitoneal shunt is one of the most popular cerebrospinal fluid diversion procedures worldwide. Complications are common, but uncommon complications are rarely reported in the literature making a standardized guideline on management of unusual complications unavailable. We report this series of uncommon complications managed in our centre to share our experience and contribute to the pool of literature on the management of these weird complications of ventriculoperitoneal shunting.Case presentationThe first case was a 10-year-old girl who presented with headache, early morning vomiting and itching over the tract of the shunt in the neck. She has had ventriculoperitoneal shunt and excision and repair of encephalocele at the age of 3 months in our facility. On physical examination, she was conscious with a Glasgow coma score of 15, and shunt valve was hardened. She had removal of the shunt with intraoperative finding of calcified shunt tubing and the valve, and also cerebrospinal fluid was under high pressure that warranted re-insertion of another medium pressure shunt. She remained stable at last follow-up 3 months post-surgery.We managed two cases of shunt extrusion via the anus (a 1-year-old female infant and 9-year-old boy). None of the patients presented with evidence of peritonitis or shunt tract infection. The extruded shunts were removed under aseptic technique, and both patients had ventriculoperitoneal shunt re-inserted because of progression of hydrocephalus. They remained stable at last follow-up visits 6 months after surgery.The fourth case was a 9-month-old infant that presented with shunt extrusion via the abdominal wound site 3 weeks after ventriculoperitoneal shunt procedure. The child developed an abscess at the abdominal wound that ruptures spontaneously with extrusion of distal catheter, had no features of peritonitis and had shunt removed and re-inserted after 3 months. The child has remained stable.ConclusionAlthough ventriculoperitoneal shunt calcification and extrusion are rare, they do occur. None of our patients had peritonitis. Shunt removal and subsequent reinsertion in the presence of raised intracranial pressure from hydrocephalus confirms an excellent outcome.

Atlanto-axial rotatory fixation complicating ventriculo-peritoneal shunt surgery: a case report and literature review

Atlanto-axial rotatory fixation (AARF) is a rare complication of ventriculo-peritoneal shunt (VPS) surgery. The authors present a unique case of AARF developing early after VP shunting, with persistent torticollis, a "cock-robin" head position, and a thick fibrous band along the catheter path. Due to refractoriness to conservative treatments, AARF, which can be an early-onset complication of VPS surgery, was resolved by removing the distal catheter along with the fibrous band encasing it. Surgical removal of the fibrous band might be enough to solve such complication with no need of further surgical fusion procedures.

Transoral migration of the inferior end of a ventriculoperitoneal shunt: A case report with literature review

Ventriculoperitoneal (VP) shunt surgery is the most widely used technique for the treatment of hydrocephalus. However, it can incur certain complications. Beside frequent complications (infection, obstruction), migration of the peritoneal catheter is a rare but dangerous complication. This report presents the case of a 4-year-old boy who had undergone VP shunt for hydrocephalus. One month later, the patient presented with protrusion of the peritoneal catheter through his mouth. He underwent another procedure to remove the peritoneal catheter, retaining the original ventricular catheter and valve chamber. Progression was favorable. To the best of our knowledge, only 7 cases of VP shunt transoral extrusion were reported, but many risk factors were identified. Bowel perforation is a serious complication of VP shunt surgery, sometimes leading to fatal outcome.

Cystoscopic Removal of Migrated Ventriculoperitoneal Shunt Tube: A Case Report with Short Review

Hydrocephalus is most commonly treated by ventriculoperitoneal (VP) shunt surgery. The distal end of the VP shunt is commonly placed in the peritoneal cavity. Various complications of the distal end of the shunt have been described in the literature. Migration of the distal end of the shunt tube into the bladder is an extremely rare complication of VP shunt surgery. Only three cases of erosive bladder perforation by a peritoneal catheter have been documented so far in the literature. We report an unusual case of perforation of the distal end of the VP shunt into the bladder with encrustation at the tip. Cystoscopic removal of the migrated distal end of the shunt tube is performed. Cystoscopic removal is simple and avoids the complications of cystostomy. The various other complications are shortly reviewed.

A rare case of complete intraventricular migration of ventriculo-peritoneal shunt

The proximal migration of a ventriculoperitoneal (VP) shunt into the ventricles is an extremely rare complication of VP shunt surgery. Only few cases have been previously reported. We report a case of a 4-month-old girl who suffered a shunt malfunction due to complete migration of the shunt assembly, including the shunt chamber, in the dilated lateral ventricles. The migrated shunt was left in situ. A new VP shunt was performed on the opposite side. Child was doing well in follow up. This case and the other reported cases are studied, and a possible causes and preventive measures are discussed.

ABSTRACT 777

Background and aims: Ventriculoperitoneal shunt (VPS) placement is the most common operation performed in the treatment of hydrocephalus. The most common complications are infection of the shunt and malfunction due to blockage. Intra-abdominal complications are also common and seen in about %10–50 of the patients. Aims: We purposed to present a one-year old patient suffering from liver hematoma after ventriculoperitoneal shunt surgery. Results: This one-year old boy had a history of prematurity (28 weeks), intracranial hemorrhage and shunt-dependent hydrocephalus. VPS was first inserted when he was 2 months old. The shunt was taken out when he was 11 months because of the retraction of the catheter through his scrotum and shunt infection. After treatment of the infection, he was taken to operation for shunt revision. In the 16 th hour after surgery, the patient had abdominal distention, hypotension, tachycardia, tachypnea and he was entubated. In the laboratory tests, the hematocrit levels decreased from 36 to 20. An ultrasound of the abdomen was done which showed liver hematoma. The CT scan of the abdomen showed massive liver hematoma measuring 9.4x4.6 cm in the right subdiapraghmatic region (Figure-1). Following a consultation at the department of pediatric surgery, the patient was re-operated. The liver hematoma was drained. He was extubated 3 days after surgery.FigureAbdominal CT. In the right subdiapraghmatic region, ther is a liver hematoma of about 9.4x4.6 cm. Conclusions: There are many complications of VPS surgery and the catheter itself. To our knowledge this is the first report describing a massive liver hematoma after shunt revision

Wandering Distal End of Ventriculo-Peritoneal Shunt: Our Experience with Five Cases and Review of Literature

Ventriculo-peritoneal (VP) shunt is the most commonly performed procedure for the management of hydrocephalus. Although shunts have improved the morbidity and mortality associated with disordered Cerebrospinal fluid (CSF) mechanics over the past 30 years, they still are associated with many potentially avoidable complications in clinical practice. However, extrusion of VP shunt catheter is an unusual complication of VP shunt Surgery. We are presenting this unusual complication in five patients. The lower end of the shunt was seen extruding from anal opening in one patient, umbilicus in one, urethra in one, inguinal hernia sac in one and oral cavity in one patient. All of these patients were managed by shunt removal, intra venous antibiotics followed by shunt replacement on the other side except the patient with inguinal hernia sac. DOI: http://dx.doi.org/10.3126/jnps.v32i3.6935 J. Nepal Paediatr. SocVol.32(3) 2012 266-269

A study on Complications of ventriculoperitoneal shunt surgery in Bir Hospital, Kathmandu, Nepal

Background: Ventriculoperitoneal shunt is one of the most commonly performed neurosurgical procedure, both on the elective and emergency basis. However this procedure is dreaded because of complications. There is lack of prospective studies on complications of shunt procedure. In this study, the indications for shunt, the types used and complications of ventriculoperitoneal shunts were studied. Methods: This was a prospective study carried out in the national neurosurgical referral centre, Bir hospital, Kathmandu from April 2004 to March 2005. Results: There were 109 ventriculoperitoneal shunt procedures during the study period. Among them 60 consecutive patients who fulfilled the inclusion criteria were enrolled for the study. There were 43 male and 17 female patients, with age ranging from 4 months to 75 years. Fourteen patients (23.3%) developed complications which included shunt block, shunt infection, over drainage and shunt extrusion. Conclusion: About one fourth all patients who underwent ventriculoperitoneal shunt surgery developed complications. Shunt block and infections were the major complications. DOI: http://dx.doi.org/10.3126/njms.v1i2.6612 Nepal Journal of Medical Sciences. 2012;1(2): 119-22

Tube Found in Anus during Defecation: Sigmoid Colon Perforation after Ventriculoperitoneal Shunt Surgery in an Elderly Patient

Bowel perforation with anal protrusion of the ventriculoperitoneal (VP) shunt catheter is a rare complication of VP shunt surgery. Most of the complications reported to date have occurred in children, and there are very few reports of complications in elderly patients. An 80-year-old man with normal pressure hydrocephalus (NPH) was treated by VP shunting by mini-laparotomy; a subsequent abdominal wall infection necessitated additional VP shunting, which was performed using the blind puncture technique. Three months after the second VP shunting, the patient presented with anal protrusion of the shunt catheter. Exploratory laparotomy revealed that the shunt catheter had penetrated the subcutaneous tissue through the mesocolon into the redundant sigmoid colon and formed a colocutaneous fistula. Subsequently, exploratory laparotomy with closure of the colocutaneous fistula, loop colostomy of sigmoid colon, and extrusion of the catheter was performed. Fever or signs of meningeal irritation, and increased intracranial pressure were not noted at the follow-up examination performed 1 month after the procedure. In conclusion, this case suggests that if the patient has a history of intra-abdominal surgery, the surgeon should exercise caution while performing the blind puncture technique for VP shunt surgery since this surgery may result in direct injury to the adhesive bowel.

Torticollis as a late complication of ventriculoperitoneal shunt surgery

The pathophysiological mechanisms related to aging of the material of a ventriculoperitoneal (VP) shunt and how mechanical stresses and mechanical traction applied to the VP shunt catheter contributed to the development of torticollis are discussed. We report a 14-year-old boy with torticollis developing as a late complication 12 years after placement of a left VP shunt for the treatment of aqueductal stenosis. The shunt tube and the surrounding fibrocalcified band were removed, and the patient’s torticollis resolved completely without recurrence. Biomechanical dysfunction of shunt material with resultant tethering at the most mobile part of the shunt tubing (neck) in a growing child can lead to the development of torticollis. To our knowledge this is the first report of this VP shunt complication.