Treatment of Cerebrospinal Fluid Shunting Complications in a Nigerian Neurosurgery Programme

Abstract

Background/Aims: For a century since the first cerebrospinal fluid (CSF) shunt surgery, ventriculoperitoneal (VP) shunt insertion for the treatment of hydrocephalus has routinely been performed. A lot of common and rare complications following this procedure have been reported in 24–47% of the cases. The aim of this paper was to present our experience with the treatment of hydrocephalus in our centre and highlight our management of two unusual complications with the available resources. Methods: Retrospective clinical review. Results: A total of 86 patients with hydrocephalus were seen in our unit. There were 52 males and 34 females (male:female ratio 3:2). The age of the patients ranged from 1 day to 68 years. The majority of the patients (92%) were below 5 years of age. Sixty-five patients had shunting procedures [VP shunt: 62 (95.4%); endoscopic third ventriculostomy: 3 (4.6%)]. Of the 62 patients with VP shunts, 16 (25.8%) had complications while 2 of the 3 patients with endoscopic third ventriculostomies had complications. The complications following the VP shunts were CSF shunt sepsis (n = 12; 19.4%), abdominal complications (n = 3; 4.8%), subdural haematoma (n = 2; 3.2%) and scalp necrosis in 1 patient. Conclusion: VP shunt procedures have come to stay and will remain with us despite recent advances such as endoscopic third ventriculostomy. Care should be taken to prevent all complications whether common or rare by paying particular attention to patient selection, shunt selection and surgical details. The adaptation of local technology and justified use of limited facilities and resources can go a long way in the management of both common and rare complications in developing nations.

Early outcome of combined endoscopic third ventriculostomy and choroid plexus cauterization in childhood hydrocephalus

“…The many possible complications associated with shunt insertion have been well documented, and in an environment where prompt access to health care facilities and/or personnel is limited, the less the neurosurgeon is needed posttreatment the better. 4,11,17,19,20 Another social advantage of endoscopic treatment is the ease with which it is accepted by parents. In our experience, many parents, while eager to accept shunt insertion when the child is ill, soon begin to pester the surgeon for shunt removal as soon as the child is perceived to be well.…”

“…11,25 In Nigeria, hydrocephalus mainly affects children, a reflection of the preponderance of young people in the population. While postinfective hydrocephalus (PIH) accounts for a major share of this condition, other congenital causes, such as neural tube defects, Dandy-Walker cysts, and aqueductal stenosis, are also commonly to blame.…”

Unusual complication of ventriculoperitoneal shunt

“…This is not different from what is seen in other settings including the developed countries. The incidence of post shunt infection is a Nigerian tertiary center is 25.7 % as documented by Komolafe et al (Komolafe et al, 2008) Other reported incidence ranges from 10-20 %. Though its been rarely seen in different neurosurgical centers, the incidence of rarer complications are not documented.…”

“…(Piatt & Garton, 2008) Infection rate in VP shunt is close to 20 % while complication rates is about 25.8 % in developing countries. (Komolafe, Adeolu, & Komolafe, 2008) Failure rate of VP shunt is high because of the different complications seen after the shunt. The complications of VP shunt include infections, shunt malfunction, shunt mechanical failures include breakage and migration.…”

Late onset scrotal migration of the distal catheter of a ventriculoperitoneal shunt in a 4-year-old male with post meningitic hydrocephalus - a case report and review of literature

“…4 Infection rate in VP shunt is close to 20% while complication rates is about 25.8% in developing countries. 5 Failure rate of VP shunt is high because of the different complications seen after the shunt. The complications of VP shunt include infections, shunt malfunction; shunt mechanical failures include breakage and migration.…”