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Updated: Mar 28, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
[Semiology of ventriculoperitoneal shunting dysfunction in children - a review]
E Neiter1, C Guarneri2, P-H Pretat1
1Service de neurochirurgie pédiatrique, hôpital d'Enfants, CHU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
Insights
Ventriculoperitoneal shunting (VPS) malfunction in children presents variably, requiring prompt recognition. Parental input is crucial for diagnosing shunt dysfunction, especially in those with prior issues.
Area of Science:
- Pediatric Neurosurgery
- Hydrocephalus Management
- Medical Device Complications
Background:
- Ventriculoperitoneal shunting (VPS) is a common treatment for hydrocephalus.
- VPS can malfunction, presenting with diverse clinical signs.
- Recognizing VPS malfunction is critical due to potential severity.
Purpose of the Study:
- To analyze the clinical presentation of VPS malfunction in children.
- To highlight the variability and key indicators of shunt dysfunction.
- To emphasize the need for timely diagnosis and intervention.
Main Methods:
- Systematic literature search on PubMed using keywords related to shunt dysfunction and hydrocephalus.
- Included 79 articles in English and French, excluding ventriculo-atrial shunts and case reports.
- Focused on clinical presentation and diagnostic predictors.
Main Results:
- Clinical presentation of VPS malfunction varies significantly with age.
- Infants often show raised intracranial pressure symptoms; older children present with vomiting and altered consciousness.
- Drowsiness, fever, irritability, and parental concerns are important indicators of shunt dysfunction or infection.
Conclusions:
- Awareness of the diverse clinical presentations of VPS malfunction is essential for prompt diagnosis.
- Parental observations are vital, particularly in children with a history of shunt issues.
- Early recognition and intervention can mitigate severe outcomes associated with shunt dysfunction.
Introduction:
Ventriculoperitoneal shunting (VPS) is a treatment of the hydrocephalus that may dysfunction. The clinical presentation of shunt dysfunction is variable. We therefore decided to focus on the clinical presentation of VPS malfunction in children, as this condition requires immediate emergency treatment and because of the sometimes confusing signs of intracranial hypertension in a shunted child.
Materials And Methods:
We searched PubMed with the following groups of keywords: (dysfunction OR blockage) AND shunting AND hydrocephalus; shunt complications AND hydrocephalus; hydrocephalus AND shunt AND malfunction. Articles dealing with ventriculo-atrial shunt were excluded. A total of 79 articles were retained for analysis (English and French). Case reports were excluded.
Results:
The clinical presentation varies by age: vomiting and alterated level of consciousness are the most frequent signs in older children, whereas infants present more often with raised intracranial pressure symptoms such as nausea, vomiting, irritability and bulging fontanel. Drowsiness is a good predictor of VPS dysfunction. An asymptomatic presentation is rare but possible. Abdominal presentation is also possible, ranging from abdominal discomfort to peritonitis. Fever, occurring a short time after the last intervention, and irritability are good predictors of shunt infection. Pumping the chamber of the VPS has a weak positive predictive value (12%). Shunt dysfunction can lead to death, with an estimated mortality rate at 1% per year during the first years.
Conclusion:
It is essential to be aware of the variability of the clinical presentation of VPS dysfunction, because of the potential severity of this condition. Also it is important to pay attention to the comments of the parents, especially if the child experienced a previous shunt malfunction.
