Experience of ventriculo-peritoneal shunt insertion in late presenting congenital hydrocephalus

Objective: to evaluate the outcomes of insertion of ventriculo-peritoneal shunts in paediatric neglected hydrocephalus. methods: the quasi-experimental study was conducted at the combined military hospital,rawalpindi,from january 2012 to june 2014,and comprised infants of both genders who presented late with congenital hydrocephalus,having fronto-occipital circumference more than 98 percentile of matched age group. pre-operative assessment was based upon detailed history,clinical examination,laboratory investigations and computed tomography scan of head. after insertion of ventriculo-peritoneal shunt,patients were followed up for outcomes. data was analysed using spss 17. results: of the 30 infants,12(40%) were girls and 18(60%) were boys. overall mean age was 7.73±1.41 months (range: 5-10 months). mean fronto-occipital circumference was 54.30±3.08. cerebrospinal fluid infection was documented in 12(40%). abdominal wound complications were observed in 7(23.3%) infants. ventriculo-peritoneal shunt was removed in 18(60%) and eventually replaced in 18(60%). in-hospital mortality on account of complications was encountered in 13(43.3%). correlation of fronto-occipital circumference to mortality was significant (p=0.001). conclusion: to shunt or not to shunt remains a dilemma for poor-risk infants,but timely reporting of infants with hydrocephalus,proper case selection may improve the outcome of surgical intervention. © 2016,pakistan medical association. all rights reserved.