Surgical-outcome and Complication Differences between Frontal and Posterior Parietal Ventriculo-peritoneal Shunts in Iraqi.

ABSTRACT

Background: Hydrocephalus, an abnormal expansion of cerebral ventricles caused by the accumulation of cerebrospinal fluid (CSF), is estimated to occur in about 3 of 1,000 live births. With a peak age of less than 10 years, hydrocephalus is more common in males than in females and is caused by brain tumours, central nervous system (CNS) infections and many other congenital malformations. Ventriculo-peritoneal (VP) shunts are basic diversionary CSF flow-channel neurosurgical procedures that are associated with a significant failure rate and a number of complications. The use of either frontal or posterior parietal VP shunts is selected based on the determined sites of insertion. Objectives: The aim of this study was to assess the differences in the complications and number of tappings between frontal and posterior parietal VP shunts. Patients and Methods: A prospective study was conducted on 113 patients with hydrocephalus of various aetiologies who were treated at a surgical specialties hospital in Baghdad between January 2010 and January 2013. The purpose of the study, which followed each patient for 6 months after surgery, was to determine the differences between 43 patients treated with frontal VP shunts and 70 patients treated with posterior parietal VP shunts with respect to the following factors number of tappings to access the ventricle, steps of subcutaneous tunnelling, duration[.6] of procedure , complication rates and incidents of revision. A Codman & Shurtleff programmable shunt was used in both groups; no antibiotic-impregnated shunts were used. Results and Discussion: The mortality rate was 1.76%; 31.85% of all shunted patients experienced post-operative complications. Of a total 113 patients, 22 patients (31.42%) with posterior parietal VP shunts developed complications, and 14 patients (32.55%) with frontal VP shunts developed complications. Revisions were required in 25.7% of the patients with posterior parietal VP shunts and in 20.9% of the patients with frontal VP shunts. The most frequent complication was upper-end obstruction, which occurred in two patients (4.65%) after the frontal VP shunt procedure and in eight patients (11.42%) after posterior parietal VP shunt procedure. The wide difference in the number of occurrences of this complication clearly demonstrates that the frontal approach as a method of choice in applying a ventricular catheter. Other complications were also recorded (e.g. lower-end obstruction, infection, seizure, tube and valve exposure and subcutaneous collection. Conclusion: Age, gender and the cause of hydrocephalus were found to have no relation to the development of shunt complications. Upper-end obstruction, valve exposure and required revisions were more common in patients with posterior parietal VP shunts, while lower-end obstruction, infection and seizures were more common in patients with frontal VP shunts. However, these differences were not statistically significant.