Extracranial complications of cerebrospinal fluid shunt function in childhood hydrocephalus

There were 112 separate hospital evaluations in 84 patients for suspected shunt malfunction: 96 evaluations were of ventriculoperitoneal shunts, 13 were of ventriculoatrial shunts, and three were of both types of shunts. In 45 (47%) of 96 ventriculoperitoneal shunts, complications eventually led to surgical revision; 20 (44%) of these were problems of the peritoneal end and therefore peculiar to this type of shunt. Peritoneal end problems included tubing disconnection, bowel obstruction, perforation, and abdominal cerebrospinal fluid pseudocyst. Of the 13 ventriculoatrial shunts, 10 (79%) required revision; eight (61%) of these were due to problems of the atrial end. These problems included relative shortening of the tubing due to patient growth, superior vena cava thrombosis, and disconnection. Ventriculoperitoneal shunts were used most frequently and had a lower complication rate (47%). Ventriculoatrial shunts were used less often and had a higher complication rate (79%) and more serious problems.