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Updated: May 7, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Ventriculoperitoneal shunt extrusion in pediatric patients, clinical patterns and therapeutic strategies: A scoping
Oday Atallah1, Amr Badary2, Fatma A Monib3
1Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
Insights
Ventriculoperitoneal shunt (VPS) extrusion in children is a serious complication. Prompt diagnosis and treatment, especially with infection, significantly improve patient outcomes and recovery rates.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Medical Device Complications
Background:
- Ventriculoperitoneal shunts (VPSs) are crucial for treating pediatric hydrocephalus.
- Shunt extrusion is a known, albeit infrequent, complication.
- Understanding extrusion's causes and outcomes is vital for pediatric neurosurgery.
Purpose of the Study:
- To comprehensively review the occurrence of VPS extrusion in pediatric patients.
- To identify the primary causes and contributing factors of VPS extrusion.
- To analyze the clinical consequences and management strategies for extruded VPS.
Main Methods:
- Systematic literature search of PubMed, Google Scholar, and Scopus (1950-2023).
- Keywords: "ventriculoperitoneal shunt" AND ("extrusion" OR "migration" OR "perforation").
- Data extraction included demographics, etiology, presentation, treatment, and outcomes.
Main Results:
- Analysis of 120 pediatric cases from 80 studies revealed extrusion complications.
- Common symptoms included cerebrospinal fluid leakage (55.8%); anal/rectal extrusion sites were frequent.
- Pre-existing infections (meningitis/peritonitis) occurred in 20%; recovery rate was 90%.
Conclusions:
- Distal catheter extrusion is a critical neurosurgical emergency requiring prompt intervention.
- Infection presence necessitates aggressive management with antibiotics and shunt revision.
- Timely and appropriate treatment of VPS extrusion significantly improves patient prognosis.
Background:
Ventriculoperitoneal shunts (VPSs) are frequently employed in neurosurgery to treat hydrocephalus, with a particular focus on pediatric patients. Although VPSs are commonly utilized, they are not exempt from difficulties, such as shunt extrusion. The main aim of this study is to enhance comprehension regarding the occurrence, causes contributing to, and consequences of VPS extrusion in pediatric patients.
Methods:
A comprehensive search approach was implemented, including electronic databases, including PubMed, Google Scholar, and Scopus, to locate pertinent articles published between January 1950 and May 2023. The utilization of keywords such as "ventriculoperitoneal shunt" and "extrusion," "ventriculoperitoneal shunt" and "migration," and "ventriculoperitoneal shunt" and "perforation" was employed. Data on patient demographics, underlying diseases, origin of extrusion, presenting symptoms, treatment, and follow-up were gathered. Statistical studies were conducted to identify potential risk factors connected with the occurrence of shunt extrusion.
Results:
A study analyzed 80 studies on 120 individuals with extruded VPS catheters. The majority of patients (55.8%) had symptoms such as cerebrospinal fluid leakage and irritation. Hydrocephalus was categorized into congenital (40%), obstructive (36.7%), and communicating (11.7%) groups. Catheter extrusion sites varied, with most from the anal or rectal site. Preoperative meningitis or peritonitis was present in 20% of patients. Treatments ranged from shunt removal to endoscopic third ventriculostomy, resulting in a 90% recovery rate, 1.7% mortality, and 5% follow-up loss.
Conclusion:
Extrusion of the distal catheter in VPSs is a critical medical situation that necessitates urgent surgical intervention. The presence of an infection raises the likelihood of complications; hence, it is vital to promptly address the issue through the administration of antibiotics and the replacement of the shunt. Timely intervention enhances results.
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