Avoidable factors that contribute to the complications of ventriculoperitoneal shunt in childhood hydrocephalus.

A personal series of 80 consecutive children who underwent ventriculoperitoneal shunting for hydrocephalus has been followed up for a period of from 6 months to 6.5 years. Complications occurred in 8 patients; these included partial occlusion of the ventricular catheter in 2, infection in 2, peritoneal catheter-valve disconnection with migration of the catheter into the peritoneal cavity in 2, fracture of the peritoneal catheter just below the valve in 1, and failure of the peritoneal cavity to absorb cerebrospinal fluid in another. Analysis of the results in the present series showed that the complications result from the technique. The operative procedures responsible for a low complication rate in the present series are described. It is concluded that to avoid shunt complications, attention must be paid to the following factors: meticulous asepsis; good surgical technique, including testing of the shunt system to make certain that the correct opening pressure is present; elimination of contact between the shunt system and the patient's skin; placement of the valve under a pericranial flap; positioning the tip of the ventricular catheter just in front of the foramen of Monro and that of the peritoneal catheter in the pelvic peritoneal cavity.