The Burden of Ventriculoperitoneal Shunt Complications: A Quest for Standardization

Abstract

Background: Ventriculoperitoneal shunt (VPS) placement is the main treatment for hydrocephalus, but infection and malfunction remain important concerns, particularly where standardized insertion protocols are limited. This study describes VPS-related complications after implementation of a standardized perioperative protocol in two Nigerian tertiary hospitals.

Methods: We conducted a prospective descriptive cohort study from December 1, 2023, to October 31, 2025. Consecutive patients with hydrocephalus requiring VPS were enrolled. The protocol included morning scheduling with neonatal priority, povidone-iodine skin preparation, prophylactic antibiotics, double gloving, minimal shunt handling, delayed shunt opening, and limited skin contact. Sociodemographic, clinical, radiologic, operative, and outcome data were analyzed descriptively. Early complications were defined as events occurring within 6 months after surgery.

Results: Ninety VPS procedures were performed in 87 patients; two were lost to follow-up. Median age was 4 years (IQR, 1–16; range, 0.08–43), and 62.1% were male. Non-communicating hydrocephalus was most common (64.4%), mainly due to congenital aqueductal stenosis. Overall complication rate was 3.33% (n=3), including two proximal obstructions and one transanal protrusion. The latter occurred in a premature, malnourished neonate who developed meningitis and died after revision, corresponding to an infection rate of 1.11% per procedure. Median hospital stay was 5 days (IQR, 4–6), and median follow-up was 4 months (range, 1–19).

Conclusions: A standardized VPS insertion protocol was associated with low complication and infection rates. However, causal inference is limited by the descriptive design and bundled intervention. Comparative studies with longer follow-up are needed.