The fate of ventriculo-peritoneal shunts and outcome of revision surgery

Abstract

Insertion of a ventriculo-peritoneal shunt (VPS) is the only effective treatment for hydrocephalus. Revision of a VPS can be indicated for infective or mechanical complications. This study aimed to investigate the middle to long-term outcome after insertion of a VPS in Zambia and the outcome after revisions.

Between August 1935 and August 1998, at St Francis' Hospital, Katete, 60 Harare type VPS were inserted in 54 children. The age range at the time of insertion was 14 days to 12 months. Twenty children (37%) underwent a revision during the study period, mainly for mechanical problems (blockage). Follow-up data were available for 22 children (40% of the total) of which six had undergone revision.

Twenty-one children still had a functioning VPS in situ. Thirteen of the 21 had moderate to severe psychomotor retardation and eight
(38%) were normal or mildly impaired. None of the six children who needed revision, were in the latter category.

Of the 54 children with a VPS, 20 (37%) needed revision within three years of insertion. The psychomotor development of these children was found to be moderately to severely delayed during follow-up. The need for revision of a VPS appears to be associated with a poor outcome.

Keywords: ventriculo-peritoneal shunt, outcome, revision, Africa