CSF Shunt Complications in Infants – An Experience from Pakistan

Abstract

Aims and Objective: The main aim of the study was to find out the postoperative complications and long-term outcome of cerebrospinal fluid-shunted patients in an infantile age group with a poor socioeconomic background. Material and Methods: A prospective study of 100 cases of infantile hydrocephalus was conducted at Pakistan Institute of Medical Sciences, Islamabad, Pakistan. All selected patients suffering from congenital and post-meningitic hydrocephalus were operated on for ventriculoperitoneal shunt. However, cases of hydrocephalus secondary to myelomeningocele were not included. Patients were followed postoperatively for 2 years. Prior consent for surgery was taken from all parents and the study was approved by the hospital’s academic and ethical council. Results: The majority of patients were brought quite late to the medical facilities because of social taboos and socioeconomic conditions. Early signs and symptoms of hydrocephalus were either ignored or misunderstood. Shunt infection and shunt failure rates remained at 14 and 10%, respectively. 50% of shunt blocks occurred in the first postoperative year and another 50% within 2 years. The highest percentage (40–45%) of death occurred in patients suffering from congenital hydrocephalus, in the first postoperative year. Conclusions: This study concluded that the outcome and prognosis of shunted infantile hydrocephalus in developing countries is suboptimal due to different socioeconomic conditions. However, under such circumstances, careful selection of patients, timely intervention and adherence to meticulous aseptic surgical techniques can alter the prognosis of cerebrospinal fluid-shunted infants.

Hydrocephalus management challenges in a low-income country: A review article

“…Other reported causes of late presentation include social taboos, low socioeconomic status, ignorance, and misunderstanding of the early symptoms of hydrocephalus. [ 5 7 8 9 ] Shunt-related complications and poor outcomes are more common in patients with delayed shunt insertion, and this is a common occurrence in developing countries. The risk factors for these include co-morbidities like anemia and malnutrition, advanced presentation, and lack/delay of adequate diagnostic imaging.…”

“…Late presentation has also been attributed to social taboos and socioeconomic conditions. [ 5 6 ] Better outcomes have been reported in patients who were shunted earlier than those who underwent late shunt surgery. [ 7 8 9 ]…”

Pediatric Neurosurgery In Pakistan: Current Status And A Call-To-Action For Inclusion In The National Surgical Plan

“…50% of patients with congenital hydrocephalus had associated congenital anomalies. Common post-operative complications included shunt obstruction (24%), infection (20%) intracerebral hemorrhage (0.5%) and subdural hematoma (0.5%) 27 . Such postoperative complications are more common in low-socioeconomic settings like Pakistan.…”

Outcomes of Endoscopic Third Ventriculostomy in Pediatric Patients With Hydrocephalus

“…However, the situation is not the same in less developed countries like Pakistan. Bakhsh reported that infants who developed complications due to CSF shunting often presented very late to the healthcare facilities due to socioeconomic conditions and ignorance [5]. The author further highlighted that up to 40% of deaths occurred in infants who had congenital hydrocephalus.…”