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Updated: Oct 16, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Management and Outcome of Post-Infectious Multiloculated Hydrocephalus: A Case Series
Abdulrazaq A Alojan1, Assayl R Alotaibi1, Hussain N Alalhareth1
1Department of Neurosurgery, Pediatric Neurosurgery Unit, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Background And Importance:
Infection following ventriculoperitoneal shunt (VPS) placement is a recognized complication, with variable incidence rates worldwide. Development of post-infectious multiloculated hydrocephalus (MLH) is likely if VPS infection is improperly managed, in turn affecting the prognosis. There is a lack of studies from Saudi Arabia regarding patients' functional outcome in relation to different variables.
Objectives:
To study the causative organisms, related variables and patient outcomes in MLH after VPS infection.
Methods:
This case series is a retrospective chart review of pediatric patients diagnosed with hydrocephalus from 2011 to 2019. Patients were included if they were aged <18 years, had confirmed cerebrospinal fluid/blood infection with radiological evidence of MLH, and were regularly followed-up. Functional status score was used to evaluate the outcomes.
Results:
A total of 150 patients underwent VPS insertion during the study period, of which 12 (8%) had postinfection MLH. The mean age at diagnosis and follow-up was 9 and 19 months, respectively. Ten patients developed MLH after their first VPS infection and one each developed MLH following the second and third VPS infections. Cerebrospinal fluid cultures mostly grew only single organisms (6/12), with Staphylococcus species being the most common. All patients underwent navigated endoscopic fenestration; nine patients required VPS placement and three required redo endoscopic fenestration surgery. All patients were developmentally delayed, with the majority (75%) having a functional status score of 6-10.
Conclusion:
Development of MLH after VPS infection is debilitating and requires prompt treatment. Although the overall functional outcome is poor, evolving neuroendoscopic techniques with tailored preoperative planning may play a role in reducing the adverse effect of shunt multiplicity, shunt infections and the higher failure rate among patients with complex hydrocephalus.
Insights
Ventriculoperitoneal shunt (VPS) infection can lead to multiloculated hydrocephalus (MLH), often resulting in poor functional outcomes for pediatric patients. Prompt treatment and advanced neuroendoscopic techniques are crucial for managing this complex condition.
Area of Science:
- Pediatric Neurosurgery
- Hydrocephalus Management
- Infectious Complications
Background:
- Ventriculoperitoneal shunt (VPS) infection is a known complication impacting hydrocephalus treatment.
- Improper management of VPS infections can lead to debilitating post-infectious multiloculated hydrocephalus (MLH).
- Limited data exists on functional outcomes in Saudi Arabia concerning MLH after VPS infection.
Purpose of the Study:
- To investigate the causative organisms in MLH post-VPS infection.
- To identify variables associated with MLH development and patient outcomes.
- To evaluate functional status in pediatric patients with MLH.
Main Methods:
- Retrospective case series of pediatric patients (<18 years) diagnosed with hydrocephalus from 2011-2019.
- Inclusion criteria: confirmed infection, radiological evidence of MLH, and regular follow-up.
- Functional status scores were used to assess patient outcomes.
Main Results:
- 12% of 150 VPS patients developed post-infection MLH.
- Staphylococcus species were the most common causative organism in cerebrospinal fluid cultures.
- All patients had developmental delays, with 75% scoring 6-10 on functional status.
Conclusions:
- Post-infectious MLH is a severe complication requiring urgent intervention.
- While functional outcomes are generally poor, neuroendoscopic techniques may improve management.
- Tailored planning is essential for complex hydrocephalus cases to mitigate adverse effects.
