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Updated: Aug 15, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Shunt revision in hydrocephalus
Raj Kumar1, Vinita Singh, Marakani V K Kumar
1Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. rajkumar@sgpgi.ac.in
Insights
Infective causes, including TORCH infections and meningitis, are a significant factor in childhood hydrocephalus. Post-infective hydrocephalus often leads to developmental delays and necessitates frequent shunt revisions.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Infectious Diseases
Background:
- Hydrocephalus affects children worldwide, with varying etiologies and outcomes compared to Western populations.
- Understanding the specific causes and complications in a local context is crucial for effective management.
Purpose of the Study:
- To analyze the etiology, clinical features, complications, and outcomes of hydrocephalus in 50 children.
- To determine the incidence of shunt revisions and compare findings with Western counterparts.
Main Methods:
- Retrospective analysis of 50 hydrocephalic children with a minimum 6-month follow-up.
- Data collected from discharge summaries, including clinical features, imaging, treatment, and shunt revision records.
Main Results:
- The most common etiologies were aqueductal stenosis (36%) and post-infective hydrocephalus (36%), including post-tubercular and bacterial meningitis, and TORCH infections.
- Fifteen children (30%) required shunt revision due to infection (16%) or obstruction (14%).
- Intra-fourth ventricular neurocysticercus cysts were identified as a rare cause of CSF pathway obstruction.
Conclusions:
- Infective etiology is a major contributor to hydrocephalus in this cohort, emphasizing the need to consider TORCH infections.
- Post-infective hydrocephalus is linked to developmental delays and mental retardation.
- A high incidence of shunt revisions was observed, particularly with medium-pressure shunts, highlighting potential challenges in long-term management.
Objective:
A retrospective analysis of 50 hydrocephalic children having a minimum follow-up of 6 months was carried out to see their etiology, clinical features, complications, incidence of shunt revisions, outcome and the variation from their Western counterparts.
Methods:
Clinical features, image findings and treatment of all the cases were recorded from their discharge summaries. Record of shunt revision complications and outcome was maintained by the principal author. The data of all the cases were analyzed.
Results:
The age of children varied from 1 month to 12 yr (mean 2.2 yr). The most common etiology of hydrocephalus was aqueductal stenosis in 18 (36%) children. Post infective hydrocephalus, either of post-tubercular meningitis (TBM) or following bacterial meningitis, remained the cause in 15 children (30%). Congenital TORCH infection was responsible for 3 cases of hydrocephalus making infective etiology as the cause in 18 (36%) cases. Intra 4th ventricular neurocysticercus cyst caused blockade of CSF pathway in 2 children. 15 out of 50 children required shunt revision, either due to infection (8,16%) or shunt obstruction (7, 14%). Multiple shunt revisions were required in 2 children only. These revisions were required due to infection, obstruction or malfunction of the shunt.
Conclusions:
Infective etiology is responsible for hydrocephalus in significant number of children (36%). The possibility of TORCH infection, as a cause of hydrocephalus should be considered even amongst the children of screened mothers during antenatal check-up. Pure intra 4th ventricular neurocysticercus cysts (without intraparenchymal cyst), though rare, can manifest with outlet obstruction. Incidence of shunt revision using Chhabra's medium pressure shunt is very high in children at an average follow up of 1.6 yr. Post infective hydrocephalus is a major cause of delayed milestones, contributing to mental retardation.
