PER-OPERATIVE FINDINGS OF BLOCKED VENTRICULOPERITONEAL SHUNT: A STUDY OF 72 CASES
Abstract
Background: Most patients with hydrocephalus are treated with ventriculo-peritoneal (VP) shuntplacement; however, malfunction is common and is usually caused by mechanical failure. The aimof this study was to evaluate the per-operative findings accompanying presumed VP shuntmalfunction. Methods: This is a descriptive study of 72 patients operated for shunt malfunction inthe Department of Neurosurgery, Postgraduate Medical Institute, Lady Reading Hospital,Peshawar from January to December 2008. Presenting symptoms and signs, clinical shuntfunction, operative findings and outcome were recorded. Results: Common presenting featureswere vomiting, irritability and general toxic look of patients. Male to female ratio was 3:1. Upperend block was observed in 39 patients while lower end and reservoir block was noted in 13 and 2patients respectively. Choroids plexus was found in 29.2% of cases with upper end block, shuntrevision was performed in most of cases (80.6%). Conclusion: The importance of clinical featurescannot be overlooked in a patient with shunt malfunction. Upper end block due to choroids plexusis common operative finding.Keywords: VP shunt, shunt malfunction, choroid plexusReferences
Goeser CD, Mcleary MS, Young LW. Diagnostic imaging of
ventriculoperotoneal shunt malfunctions and complications.
Scientific Exhibit 1998;18:635–51.
Iskandar BJ, Mclaughlin C, Mapstone TB, Grabb PA, Oakes
WJ. Pitfalls in the diagnosis of ventricular shunt dysfunction;
radiology reports and ventricular size. Pediatrics
;101:1031–6.
Sacar S, Turqut H, Toprak S, Cirak B, Coskon E, Yilmaz O,
et al. A retrospective study of central nervous system shunt
infections diagnosed in a university hospital during a 4-years
period. BMC Infect Dis 2006;6:43–7.
Somadani AF, Storm PB, Kuchner EB, Garonzik IM,
Sciubba D, Carson B. Ventriculoperitoneal shunt malfunction
presenting with pleuritic chest pain. Pediatr Emerg Care
;21:261–3.
Lee TT, Uribe J, Ragheb J, Morrison G, Jagid JR. Unique
clinical presentation of pediatric shunt malfunction. Pediatr
Neurosurg 1999;30:122–6.
Bhatnagar V, George J, Mitra DK, Upadhyaya P.
Complications of cerebrospinal fluid shunts. Indian J Pediatr
;50:133–8.
Kaufman BA, Mclone DG. Infection of cerebrospinal fluid
shunts In: Scheld WM, Whitley RJ, Durack DT editors.
Infection of the central nervous system. New York: Raven
press; 1991. p. 561–85.
Morrice JJ, Young DG. Bacterial colonization of Holter
valves: A ten years survey. Dev Med Child Neurol
;16:85–90.
Olsen L, Fryberg T. Complications in the treatment of
hydrocephalus in children. Acta Pediatr Scand 1983;72:385–90.
Schoenbaum SC, Gardener P, Shillito J. Infections of the
cerebrospinal fluid shunts; epidemiology, clinical
manifestations and therapy. J Infect Dis 1975;131:543–52.
Sainte-Rose C, Piatt JH, Renier D, Pierre-Kahn A, Hirsch JF,
Hoffman HJ, et al. Mechanical complications in shunts.
Pediatr Neurosurg 1991–92;17:2–9.
Lazareff JA, Peacock W, Holly L, Ver Halen J, Wong A,
Olmstead C, et al. Multiple shunt failures: an analysis of
relevant factors. Childs Nerv Syst1998;14:271–5.
Barnes NP, Jones SJ, Hayward RD, Harkness WJ, Thompson D.
Ventriculoperitoneal shunt block: what are the best predictive
clinical indicators? Arch Dis Child 2002;87:198–201.
