Preventing the Preventable-Addressing VP Shunt Complications in Paediatric Hydrocephalus: A Clinical Perspective

Abstract

Background: Ventriculoperitoneal (VP) shunt placement remains the primary treatment for pediatric hydrocephalus, yet complications continue to pose significant challenges. This study aimed to evaluate the spectrum, timing, and management of VP shunt complications in pediatric patients, with particular attention to identifying risk factors for adverse outcomes.

Methods: A combined retrospective and prospective observational study was conducted between February 2023 and March 2024, analyzing 40 pediatric patients (aged <12 years) who experienced VP shunt complications from a total cohort of 116 shunt procedures. Patient assessment included clinical examination, laboratory tests, and comprehensive imaging studies. Complications were classified as early (<6 months) or late (>6 months), and outcomes were analyzed using SPSS version 25.

Results: The study revealed a male-to-female ratio of 1.5:1, with a mean age at shunt placement of 4.18 months. Mechanical complications were predominant (52.5%), followed by infectious complications (27.5%). Early complications occurred in 45% of cases, while 55% were late complications. Aqueductal stenosis was the most common etiology (42.5%), followed by tubercular meningitis (25%). A weak negative correlation (r = -0.21) was observed between age at surgery and complication risk. The overall mortality rate was 7.5%. Notably, 70% of patients who experienced complications had undergone shunt placement within the first three months of life.

Conclusions: This study identifies early age at shunt placement, particularly within the first three months of life, as a critical risk factor for VP shunt complications. The higher-than-literature infection rate (27.5% vs 5-8%) warrants attention to preventive protocols. Our findings emphasize the need for heightened vigilance in very young patients and suggest that timing of initial shunt placement may be a modifiable risk factor for complications.