Related Experiment Video
Updated: May 15, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Analysis of factors affecting ventriculoperitoneal shunt survival in pediatric patients
Farid Khan1, Muhammad Shahzad Shamim, Abdul Rehman
1Section Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan. drfaridkhan@hotmail.com
Insights
Ventriculoperitoneal (VP) shunt failure in pediatric hydrocephalus patients was analyzed over six years in a developing country. Factors like meningitis, aqueductal stenosis, and prematurity were linked to higher shunt failure rates.
Area of Science:
- Neurosurgery
- Pediatric Medicine
- Global Health
Background:
- Ventriculoperitoneal (VP) shunts are crucial for managing pediatric hydrocephalus but are prone to complications.
- Developing countries face unique challenges in shunt management due to resource limitations.
- Understanding factors affecting shunt failure is vital for improving patient outcomes.
Purpose of the Study:
- To evaluate the 6-year experience of VP shunt insertion in pediatric patients in a developing country.
- To identify specific factors contributing to VP shunt failure in this population.
Main Methods:
- Retrospective analysis of 113 pediatric patients (<15 years) who underwent VP shunt insertion between 2006 and 2011.
- Kaplan-Meier curves and Logrank (Cox-Mantel) tests were used to analyze shunt survival rates.
Main Results:
- The most common causes of hydrocephalus were congenital (19.5%), brain tumors (14.2%), and postcranial surgery (13.3%).
- Overall shunt failure rate was 23% with a median time to failure of 68 days.
- Meningitis, aqueductal stenosis, postcranial surgery, Caesarean delivery, congenital abnormalities, prior mass lesion excision, brain tumor location, and prematurity were associated with increased shunt failure.
Conclusions:
- Premature infants and patients with specific conditions (meningitis, aqueductal stenosis, postcranial surgery hydrocephalus, congenital abnormalities, prior mass lesion excision) face higher risks of early shunt failure.
- The observed 23% shunt failure rate is lower than previously reported in literature.
- Rigorous periodic evaluation of patients with VP shunts in situ may contribute to improved outcomes.
Purpose:
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 6 years' experience with VP shunt insertion in pediatric patients from a developing country, focusing particularly on factors affecting shunt failure.
Methods:
Patients aged below 15 years, 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.
Results:
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 11 months was 23 % with the median time to first shunt failure being 68 days. 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).
Conclusion:
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.
