From the Guidelines
The most common complications of ventriculoperitoneal (VP) shunts include mechanical failure, infection, obstruction, overdrainage, and migration of the shunt components. These complications can lead to significant morbidity and mortality if not promptly addressed. Mechanical failure occurs when the shunt system malfunctions, often due to disconnection or breakage of components 1. Infections typically develop within the first few months after placement, with Staphylococcus epidermidis and Staphylococcus aureus being the most common pathogens. Obstruction can occur at any point along the shunt system but frequently happens at the ventricular catheter due to tissue debris or choroid plexus ingrowth. Overdrainage syndrome results when too much CSF is drained, causing headaches when the patient is upright. Shunt migration involves displacement of components from their intended position, potentially causing dysfunction or injury to surrounding structures.
Some key points to consider when evaluating VP shunt complications include:
- Monitoring for signs of increased intracranial pressure (headache, vomiting, altered mental status), which may indicate shunt malfunction requiring prompt medical attention 1
- Evaluating patients with new or changed mental status alteration, nausea and vomiting, or gait abnormality for shunt failure, which may or may not be associated with superinfection by bacteria or other microorganisms 1
- Considering the possibility of introducing a shunt infection or causing a malfunction when performing a shunt tap to sample the CSF for infection or to evaluate the patency and function of the shunt apparatus 1
- Exploring the non-functioning shunt by evaluating proximal and distal flow intraoperatively to tailor revision to the particular area of failure 1
Overall, the management of VP shunt complications requires a comprehensive approach that takes into account the potential risks and benefits of different interventions, as well as the individual patient's clinical presentation and medical history.
From the Research
Common Complications of Ventriculoperitoneal Shunts
The most common complications of ventriculoperitoneal (VP) shunts include:
- Infection: Shunt tube infection is a severe complication with high morbidity and substantial mortality 2
- Obstruction: Obstruction is the most common complication of VP shunts, with rates barely decreasing despite technical advances 3
- Shunt malfunction: Shunt malfunction occurred in 7.3% of patients and all needed revisions 4
- Subdural hematoma: Subdural hematoma is a potential complication of VP shunts 4
- Slit ventricle syndrome: Slit ventricle syndrome (SVS) is a well-known chronic complication of VP shunt placement 5
- Abdominal complications: Abdominal complications, such as intestinal obstruction and necrosis, are rare but can occur 6
Causes of Complications
The causes of these complications include:
- Antibiotic resistance: The development of antibiotic resistance has led to rising morbidity and mortality in shunt infections 2
- Valve design: The type of valve design can contribute to the incidence of proximal shunt obstruction 3
- Infection: Previous infection can increase the risk of shunt obstruction 3
- Catheter placement: The placement of the catheter can contribute to abdominal complications, such as intestinal obstruction 6
Treatment and Prevention
Treatment and prevention of these complications include:
- Empirical antibiotic therapy: Empirical antibiotic therapy is recommended for prophylaxis and suspected infection in VP shunt surgery 2
- Valve selection: The selection of the appropriate type of valve design can help decrease the incidence of proximal shunt obstruction 3
- Prompt treatment: Prompt treatment is essential in cases of abdominal complications, such as intestinal obstruction 6