Evaluation of ventriculoperitoneal shunt malfunction regarding ventricular catheter placement

Background: Shunting procedures specifically ventriculoperitoneal shunts are the main line of treatment for management of hydrocephalus despite available new techniques and systems of shunting. Associated complications should be recognized and managed properly,but the most recognized complications are shunt obstruction which its prevalence through surgical approach is discussed here. Two approaches (frontal and parietal) are used to insert ventriculoperitoneal shunt. In this study we retrospectively examined patterns of shunt failure in patients with symptoms of shunt malfunction. Factors analyzed included site of failure, time from shunt placement or last revision of failure, age of patient at time of failure, infection and primary etiology of hydrocephalus. Two approaches were compared to determine which one is more associated with shunt failure. Methods: 250 patients with symptoms of shunt malfunction over 4 years period were retrospectively examined, in 126 cases who were shunted through frontal approach, 48 cases and in 124 patients whose shunts were inserted through parietal approach 64 cases of malfunction observed. All data was analyzed with SPSS software and with T-test,and then the failure rate for frontal versus parietal approach was compared. Results: Significant difference in malfunction rate between these two approaches regardless of underlying cause of ventriculoperitoneal shunt failure was observed, with the less failure rates through frontal approach. Conclusion: Although proximal obstruction is the most common cause of ventriculoperitoneal shunt failure and frontal approach demonstrated less failure rate, but as it is known placing the catheter tip away from the choroids plexus is the most important factor avoiding obstruction.