Background/Aims: Ventriculoperitoneal shunt complications have scarcely been reported in sub-Saharan Africa. This study aimed at determining the frequency of these complications and their associated risk factors in a Kenyan National Teaching and Referral Hospital. Methods: This cross-sectional study retrospectively covered 117 patients admitted to the Kenyatta National Hospital neurosurgical ward between January 2005 and December 2007 with ventriculoperitoneal shunt complications. The data obtained were analysed using the Statistical Package for the Social Sciences. Results: The most common complication was obstruction in 63 patients (53.8%), followed by migration in 25 (21.4%) and infection in 23 (19.7%) of the patients. Up to 49.6% of the complications occurred in patients younger than 6 months. Multiple complications were seen in 23.9% of the cases. The mean shunt duration was 18.05 months. Positive correlations existed between the presence of a shunt complication and patient age, shunt duration and the number of complications developed. These correlations were, however, neither strong nor statistically significant. Conclusion: This study reports the highest frequencies of shunt obstruction and migration ever recorded in the literature. The high rate of development of multiple shunt failures coupled with a short shunt duration calls for a closer monitoring of patients with ventriculoperitoneal shunts.

Keywords:
Cerebrospinal fluid, Complications, Risk factors, Ventriculoperitoneal shunt
1.
Bauman N, Poenaru D: Hydrocephalus in Africa: a surgical perspective. Annals Afr Surg 2008;2:30–37.
2.
Garton H, Piatt J: Hydrocephalus. Pediatr Clin North Am 2004;51:305–325.
3.
Bondurant CP, Jimenez DF: Epidemiology of cerebrospinal fluid shunting. Pediatr Neurosurg 1995;23:254–258.
4.
Casey AT, Kimmings EJ, Kleinlugtebeld AD, Taylor WA, Harkness WF, Hayward RD: The long-term outlook for hydrocephalus in childhood: a ten-year cohort study of 155 patients. Pediatr Neurosurg 1997;27:63–70.
5.
Rad MF, Vahedi P, Shoeibi A: Cerebrospinal fluid shunt complications: a 10-year study of etiologies and cerebrospinal fluid characteristics. Neurosurg Q 2005;15:1–4.
6.
Piatt JH Jr, Carlson CV: A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience. Pediatr Neurosurg 1993;19:233–242.
7.
Griebel R, Khan M, Tan L: CSF shunt complications: an analysis of contributory factors. Childs Nerv Syst 1985;1:77–80.
8.
Cho KS, Hong YK, Park CK, Baik MW, Kim MC, Kang JK, Song JU: Post-shunt complications in hydrocephalus: analysis of 64 operated patients. J Korean Neorosurg Soc 1988;17:1323–1330.
9.
Lee JY, Wang KC, Cho BK: Functioning periods and complications of 246 cerebrospinal fluid shunting procedures in 208 children. J Korean Med Sci 1995;10:275–280.
10.
Starreveld Y, Poenara D, Ellis P: Ventriculoperitoneal shunt knot, a rare cause of bowel obstruction and ischemia. J Neurosurg 1998;41:239–240.
11.
Quigley M, Reigel D, Kortyna R: Cerebrospinal fluid shunt infections: report of 41 cases and a critical review of the literature. Pediatr Neurosci 1989;15:111–120.
12.
Mwang’ombe NJ, Omulo T: Ventriculo-peritoneal shunt surgery and shunt infections in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi. East Afr Med J 2000;77:386–390.
13.
Kanev PM, Sheehan JM: Reflections on shunt infections. Pediatr Neurosurg 2003;39:285–290.
14.
Cochrane D, Kestle J, Steinbok P, Evans D, Heron N: Model for the cost analysis of shunted hydrocephalic children. Pediatr Neurosurg 1995;23:14–19.
15.
Kast J, Duong D, Nowzari F, Chadduck WM, Schiff SJ: Time-related patterns of ventricular shunt failure. Childs Nerv Syst 1994;10:524–528.
16.
Lazareff JA, Peacock W, Holly L, ver Halen J, Wong A, Olmstead C: Multiple shunt failures: an analysis of relevant factors. Childs Nerv Syst 1998;14:271–275.
17.
McGirt MJ, Leveque JC, Wellons JC III, Villavicencio AT, Hopkins JS, Fuchs HE, et al: Cerebrospinal fluid shunts survival and etiology of failures: a seven-year institutional experience. Pediatr Neurosurg 2002;36:248–255.
18.
Liptak GS, McDonald JV: Ventriculoperitoneal shunts in children: factors affecting shunt survival. Pediatr Neurosci 1986;12:289–293.
19.
Tuli S, Drake J, Lawless J, Wigg M, Lamberti-Pasculli M: Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg 2000;92:31–38.
20.
Liptak GS, Masiulis BS, McDonald JV: Ventricular shunt survival in children with neural tube defects. Acta Neurochir (Wien) 1985;74:113–117.
21.
Pople IK, Bayston R, Hayward RD: Infection of cerebrospinal fluid shunts in infants: a study of etiological factors. J Neurosurg 1992;77:29–36.
© 2010 S. Karger AG, Basel
2010
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.