Accepted

Manuscript

Management of Hydrocephalus with Ventriculoperitoneal

Shunts: Review of 109 Cases of Children

Thomas K. Dakurah, MB ChB, FWACS, Fuseini Adams, MB ChB,

MWACS, Mutawakilu Iddrissu, MB ChB, FWACS, George Kojo Wepeba,
MD, MCLN, Harry Akoto, MB ChB, FWACS, Patrick Bankah, MB ChB,
FWACS, Mawuli Ametepe, MB ChB, FWACS, Philip W. Kasu, MB ChB

PII: S1878-8750(16)30499-5

DOI: ​10.1016/j.wneu.2016.06.111

Reference: WNEU 4270

To appear in: ​World

Neurosurgery

Received Date: 3 February

2016

Revised Date: 25 June

2016

Accepted Date: 27 June

2016

Please cite this article as: Dakurah TK, Adams F, Iddrissu M, Wepeba GK, Akoto
H, Bankah P, Ametepe M, Kasu PW, Management of Hydrocephalus with
Ventriculoperitoneal Shunts: Review of 109 Cases of Children, ​World Neurosurgery
(2016), doi: 10.1016/j.wneu.2016.06.111.

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ACCEPTED MANUSCRIPT
Dakurah
MANAGEMENT OF HYDROCEPHALUS WITH VENTRICULOPERITONEAL
SHUNTS: ​AUTHORS:
Dakurah MB ​Patrick​AFFILIATIONS a​ ​Dentistry(SMD), ​AUTHOR ​Dakurah ​Korle-Bu +233
b​
Division Korle-Bu ChB,
​ 208152969 a​​ , ​MB ​Thomas ​FWACS, Thomas Teaching ​of

INFORMATION ​Teaching REVIEW

​ ​Neurosurgery, ChB,
​ ​ A​ P. ​K​Wepeba

C​ C​
(corresponding FWACS, Hospital, ab​
​ O. ​Hospital, ,​ ​ MB Box ​OF ​ ChB, 4236, ​109

E​ P​
​
Ametepe ​George Department ​ ​
P. P. CASES
​ ​O. FWACS, ​O. Accra,
​ ​ author) Box

T​ E​
​
KojoBox Mawuli
​ ​ 77, a​​ Ghana, ​77, OF
​ ​Adams ​, ​of MD,
​ ​ Accra, ​Surgery, Accra,

D​
CHILDREN ab​
​ ​ CLN, ​FuseiniM
,M ​ B West Ghana, ​Ghana, ChB,
​ ​ M​ University
 A​ N​
Africa Akoto b​​ , MB FWACS, West ​ West Harry
​ ​ hB, ​
C Africa. ​of Africa. Kasu
​

U​ a​
S​ C​ R​ b​
Ghana MWACS,
​ ​ , ​MB ​ Philip ​ChB, ​School ​ Iddrissu ​W​FWACS, ​ , ​of

I​ P​ T
MB ​Medicine ​ Mutawakilu​ ChB Bankah ​

and
a​
,
tomdakurah@gmail.com
1
ACCEPTED MANUSCRIPT
Dakurah
Adams F ​ useini, MB ChB, MWACS
Korle-Bu Teaching Hospital, P. O. Box 77, Accra, Ghana, West Africa
+233 246814846
dradamsfuseini@yahoo.com
Iddrissu Mutawakilu MB ChB, FWACS
Korle-Bu Teaching Hospital, P. O. Box 77, +233 277559299
muta.iddrissu@gmail.com

Wepeba Korle-Bu +233 wepeba@hotmail.com 503930293 George Teaching ​ A​ Kojo

 C​ C​
Hospital, ​ MD, ​ MCLN

E​ P​ T​ E​ D
P. ​ O. ​ Box ​ 77, ​2 ​ Accra, ​

AN​
Ghana, ​ M​ West ​ Africa

USCRIPT
Accra, Ghana, West Africa
​ arry​, M
Akoto H ​ B ChB, FWACS
L 205, Block 4, SSNIT Flats, Alexander Avenue, Korle Bu, Accra, Ghana, West Africa
ACCEPTED MANUSCRIPT
Dakurah
+233 244257141
harryakoto@hotmail.com
Bankah K​ orle-Bu +233 bankah@hotmail.com
Ametepe K ​ orle-Bu ametmk@yahoo.co.uk +233 Philip Korle-Bu 244375575 244522770

Worlanyo Patrick​, ​Teaching Teaching Teaching Mawuli, MB ​A​ Kasu, MB Hospital,

 C​ C​
Hospital, Hospital, ChB, ​ ChB, MB ​ FWACS ChB

E​ P​ T​ E​
FWACS P. P. P. ​ O. O. O. ​ Box Box Box ​ 77, 77, 77, ​ Accra, Accra,

D
Accra, ​

AN​
Ghana, Ghana, Ghana, ​M​ West West West ​ Africa Africa

USCRIPT
Africa ​

+233246591191
philipkasu74@gmail.com
3
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Dakurah
ABSTRACT
Background
Treatment of hydrocephalus by shunting procedure is associated with variable outcomes,
depending on the setting. Results from some published series in sub-Saharan Africa are not as
good and various reasons have been given. This study presents preliminary findings of 109 cases
of shunted hydrocephalus in children in a three-year period.
Objectives
The main aim of the study was to evaluate the complications of the procedure in a tertiary care
centre. It also seeks to identify ways of reducing such complications where appropriate in
subsequent shunt placement procedures.
Methodology
A single-institutional, retrospective study was conducted by reviewing124 patients who had
ventriculoperitoneal shunting (VPS) including revisions and subgroup analysis was done in 109
patients less than 18 years old classified as children who had first-time shunt placement;between
January 2011 and December 2013. Data analysis was done using Microsoft Excel and SPSS
(Version 20.0).
Results
The mean age at shunt insertion of the subgroup was 5.35 ±1.264 SD years. Shunt-related
complications were identified in 37 of the patients(33.9%). Infections were the most common
form of complication occurring in 16 patients (14.6%). The overall mortality of the 109 patients
was 4.59%.

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M​
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Dakurah

Conclusion.​

The most common indications for shunt insertions were tumoural and congenital lesions and that
 ​ ey ​Saharan ​words​: o​ ffer ​Africa, ​hence us
may Comprehensive problem; outcomes. K

CC​
​ orle-Bu ​
ventriculo-peritoneal ​benefit follow-up the K A​ need with ​ for the of

E​ P​ T​
Teaching ​properly these use ​ of ​shunt ​ ​ ospital. ​
patients endoscopic H designed

E​ D ​
(VPS), ​ may ​ hydrocephalus, ​third prospective give ​ M​ a ventriculostomy.

A​ N​ U​ S​
better ​ studies ​ picture ​complications, ​ to of ​ improve the

C​ R​ IP​ T ​
magnitude ​ outcome, ​the current ​ of s​ ub- ​ the
 5
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Background
Introduction
Shunt the diversion progressive hydrocephalus a Treatment performed associated century,
Throughout of The literature.(6-8) outcomes, sub-Saharan some mortality socioeconomic health
complications antimicrobial- available space- over Korle-Bu issue series, placement drainage
professionals, occupying the in rate or depending of with in of most procedure the cerebral Africa
59.8% shunting hydrocephalus 1908 of impregnated occur Teaching in Treatment shunt profile last

C​
A​ as disordered for centres.(10) 7.1%.(12,14) the a lesion half ​ are by hydrocephalus

either result of dysfunction. on is infections sub–region among of Krauch. procedures not

C​
ventriculoperitoneal century; ​ still the Hospital, and of the of as shunts.(9,10) cerebrospinal

E​
good setting ​ associated hydrocephalus with siphon congenital post- population, Reasons
 P​
others. Although ​ the has and Disorders ventriculoperitoneal include infective is in in have

T​ E​
predominant effect ​ a arisen which various Accra. Some with common for ​ conditions

D
However, fluid disorders and and shunts endoscopic such ​

by events potentially shunt of the with interventions Patients reasons or shunting mechanics late

cerebrospinal surgical procedure results theme gravitational ​M​ have such or (VPS) facilities

A​
variable or of as have ​ shunt avoidable non-recognition third in improved in cerebrospinal as

N​
include the procedure procedure placement shunt following ​ need such is results been for
 U​
aimed interventions is ventriculostomy done. effect fluid ​ neuroendoscopy an poor design as

S​
of complications.(1-3) given.(9-14) the of ​ established at Results is hydrocephalus

cerebrospinal (CSF) .(4,5) at meningitis. health intracranial outcome the morbidity associated fluid

C​ R​
has reducing of Neuroscience shunt enumerated been circulation ​ from infrastructure,

I​ P​
flow and For is procedure; ​ are the and some haemorrhage, with morbidity ​ poor,

T
shunt-related fluid resulting instance, over the not prevention ​

mortality
variable such parts Unit readily use with in half (CSF) first
low the
by of
as
of of in
in a
a
Although the procedure is associated with mortality rates ranging from 0.1% to 0.13% in some
series, morbidity rates are much higher, occurring in 34% to 47%. 15,
​ 16​The factors responsible for
shunt failures are numerous and have been well enumerated in the current literature.(17-19)
6
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Shunt-related complications remain a major challenge in the field of neurosurgery.(2,4,19) Since
the introduction of shunting procedure for hydrocephalus; shunt-related complications do occur
despite the application of varied interventions.(5, 7, 8, 22) Most children in sub-Saharan Africa
who need these procedures are of poor socioeconomic background and their parents generally
cannot follow-ups.(9) complications ​Aim ​The centre ​Methods ​A ventriculoperitoneal less of
Korle-Bu beyond. a 7 ​ ​single-institutional, bed the than aim ​and ​Korle-Bu in capacity afford The
order 18 of ​Objective and ​Teaching years the neurosurgical ​Materials ​in the Therefore, to

C​
Teaching study ​ A​ the of identify old cost ​ of ​shunting 40, centre Hospital classified

C​ E​
retrospective was ​the ​of ​ a the ways Hospital, shunts ​Study ​unit and to six ​ including

P​
purpose evaluate is to of is as bed ​ the and suggest a reducing children. study in part ICU
 T​ E​
main Accra, of the the revisions. of ​ the was possible management and the

D​
complications such referral The study ​ Ghana. conducted surgical a study complications A

A​
weekly interventions ​ M​ was sub-group centre was department to ​ of by of illustrate

N​
outpatient conducted for associated reviewing124 ​ shunt patients analysis in where

U​ S​
subsequent of procedures the ​ at this attendance morbidity appropriate. was from

C​ R​ I​
problem the ​ tertiary patients Neurosciences done ​ shunt within in of and in ​ of
 P​ T
hospital. a who ​ placements. shunt-related 109 tertiary Ghana about subsequent ​

had
patients
Unit
It 150. care
and
has
Ventriculoperitoneal shunting (VPS) procedure is done as part of general neurosurgery, either,
electively or as an emergency. Approximately, eight of these procedures are done monthly. The
Chhabra shunt system is used in all cases because of its low cost and ease of availability. The
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clinical records of patients who presented at the unit during the study period were obtained. A
clinical and radiological diagnosis of each patient was made at admission during the study period
from January 2011 to December 2013.
A aetiology of using ​Inclusion I​ nclusion study ​Exclusion ​Patients referred ​Main ​Shunt /
RESULTS ​or database complications, blockage, SPSS period ​Outcome ​infection who to of was
criteria criteria t​ he was version hydrocephalus, and had and based centre rate, created ​Measures

C​
A​ duly shunt as mortality 20.0 well ​ mechanical on were consenting placements using

C​ E​
patients ​ and as excluded. follow-up rates date Microsoft ​ Microsoft in and/or of
 P​ T​
were to the done initial undergo ​ reviews. determined. centre Excel. hardware Excel

E​ D​
elsewhere ​ shunting, the ​ undergoing to The procedure. include failure, ​ M​ and

A​ N​
any data developed revision ​ patient shunt collected a first-time ​ migration,

U​ S​ C​
demographics, ​ procedures, shunt-related was ​ shunt coded ​ shunt procedure

R​ I​ P​ T​
frequency ​ and type complications obstruction ​ analysed ​ and during and ​ type

and
the
The authors reviewed VP Shunts insertions and shunt revisions in 124 patients. A total of 109 of
the patients (87.9%)who had first-time shunt insertions were less than 18 years and they were
8
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Dakurah
sub-grouped as children. Table 1 identified the estimated mean age of the children at shunt
insertion as 5.35 years with a standard deviation of 1.264, which shows less variation within the
data. About 23 of the patients (21.1%) were less than 6 months of age. Thirty-seven of the
patients and between Table complications. The infections (13.5%), Table SD within 36 The
common accounted the malformation to cause months months. cases 6 various aetiology 2 3 years 6
identified identified were 13 and hydrocephalus and (53.2%), cause (0.8%). for (5.4%) and of

About types 12 five between accounted 21 of age The months 17 ​ A​ of hydrocephalus of

C​
disconnections that of the . A eight (31.2%), years remaining six ​ the shunt-related

C​
post-infective mean majority 37 6 shunt (24.3%), cases in months within ​ for of of 12 age

E​
duration the 17 12 tract ​ 72 of of of of 3 were (2.8%). patients and in (13.5%). threebetween

P​
(66.1%) ​ hydrocephalus months the leaks the complications 30 the before hydrocephalus 12
T​ E​
between patients(13.7%). cases was study (16.2%), months (33.9%) ​ (21.6%),15 did due

D​
shunt–related (13.7%). ​ not population 7 13 to of years (16.9%). classified (Fig1) five have

and age aqueductal ​ M​ was between Arnold–Chiari for and 24 (33.9%). any Twenty-one

A​
identified ​ migrations is months(8.1%) complications Cerebral pyogenic 12 as shunt-related

N​ U​
as ​ children years 4 stenosis distributed and Thirty-four ​ included abscess of of 6

S​
(13.5%), malformation ​ bacterial months(40.5%), had age the (24.2%). started and
 C​ R​
complications. ​ in shunt-related cases (11%) the accounted were two Figure ​ five

I​ P​
following: as meningitis. between were Dandy–Walker between ​ and 8.01 blockages was ​ 2.

T
three for caused ± The identified nine ​

3.219
16 25 one 1 were most
This year
and
by of
posterior fossa tumours (16.9%). Pineal region tumours caused hydrocephalus in 11 of the
patients (8.9%). Brainstem tumours accounted for five of causes (4.0%). Cerebellopontine Angle
(CPA) tumour was identified in three of the patients (2.4%) and another three cases were caused
by craniopharyngioma(2.4%) (Figure 2).
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Figure 3: Survival Function of Shunt and Non – shunt Related Complications in Patients.
Shunt-related complications have a higher curve than non-shunt-related complications (Figure
3). In addition, the shunt-related complications have a higher risk of occurring within the first 12
months after surgery. The chances of shunt-related complications occurring are usually higher in
the complication The related differences conclude complications The for other of given. 1.553
related months complications the The related 0.001 Tarone-Ware. that ​DISCUSSION ​the
non-shunt 109 fourth complications overall number Wilcoxon related SD medical for The
complications, complications complications patients (range Log-rank that with estimated and in
tests of terminations will related are the This may team test 12.983 censored an the was sixth

C​
A​ of set different. group start estimated was the start implies ​ 4.59%. to (Mantel-Cox);

survival in complications mean month. were the and to equality make for past used

C​ E​
events(Table earlier mean. over 33.017). mean both non duration that all that ​ long-term

to median Any curves the statistically of shunt-related – Since time than compare time. there

P​ T​
shunt-related survival three-year These point was 0.064 for ​ was non-shunt-related of 5)

E​
the is of follow-ups shunt-related five ​ 7.00 a for the findings 18.956 on significance for

D​
shunt-related times statistically significant shunt-related ​ (6.90%). period. and survival the

months Breslow complications. across months non-shunt-related survival ​ M​ may due The
 A​
complications These distribution (range value at significant ​ to the complications.

(Generalised imply research ± complications 5% inaccurate complications curve groups 1.640

N​ U​
represent of 5.862 since that The ​ the waslimited SD shows difference (shunt-related

S​
between the complications. to test ​ the to test records Wilcoxon); and the set The chances

C​ R​
8.138). ​ significant was was and statistic the the in number patients overall ​ was and

I​
due less nine between probability median non-shunt-related For of and ​ 9.00 to contact was and
 P​
than (24.30%) of ​ shunt-related non-shunt values mortality the with non-shunt- deaths was

T​
0.009 months the based ​ 0.05, inability

details shunt- that 23.00

times were and and we
for on
of ±
–a
Ventriculoperitoneal shunt (VPS) placement to treat hydrocephalus forms an important part of
neurosurgical procedures; accounting for 13% of all neurosurgical procedures. There is a general
10
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trend towards increase in case load over the period studied; hence there is the need to study the
reasons for shunt failure in the centre.
There surgery On placement Shunt migration our The The lesions. common. ventriculostomy The
series. months shunt 23.00 a series. aetiology most overall global –related months was (15,16).
infection ± in This common (9,10) 1.553 rates the than a shunt-related scale, fair differs (range

literature. of complications, The in are SD The ​A​ distribution for is hydrocephalus the

C​
hydrocephalus indications estimated known higher with from CSF ​ findings 12.983 adult
 C​ E​
an diversion morbidity findings in population. to estimated to by ​ may children mean

P​
the occur for 33.017). sex for ​ mean is shunt in be in shunt duration that common rate East

T​ E​
more an ​ this median less (2,8,11) time These has placement was indication ​ placement

D​
Africa category than commonly no was for 33.9% in ​ of findings significant the

shunt-related 18 7.00 and 18.956 for in of ​M​ paediatric months which was Nepal months our

A​
patients. the may in ​ months known study use influence infants, is where of imply
 N​ U​
comparable (range age complications of age were for ± ​ endoscopic group

S​
post-infective 1.640 that (2, and all on 5.862 congenital ​ 13) 109 the the shunt with SD to

C​ R​
chances and to outcome cases. 24% to and third higher 8.138). ​ disconnection set that

I​ P​ T
and the aetiology to ​ in of 47% ​ was of rate tumoural median was For shunt- shunt ​

found in shunt
non- 9.00 is
some
was
and
in
related complications may start earlier than non-shunt-related complications. Within the first
year, shunt failure occurs up to forty percent, with an estimated ten percent infection rate;
making it one of the neurosurgical procedures with high complication rate.1, 2
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Shunt Infection
Shunt infection still remains a significant common complication of shunt surgery despite the
introduction of varied complications were as a procedure per year. Shunt series in sub-Saharan
Africa follow-ups(9.1% and 9.7%). enumerated in the literature. leak, and contamination observed
to decrease the enormous economic burden. Other Shunt Complications Shunt migration,
disconnection, shunts, respectively (3.70% - ​Shunt Migration
Shunt migration is described migration considered broken parts; occurs as or shunt even

C​ C​
A​ distally; ​ infection the ​12 ​interventions.(5,7,8,21-24) ​ IQ result usually through

E​ P​
infections Observed each). of (28-30) ​ Significantly however (25,27) affected of as ​ and

T​
through infections. occurring breached ​ in accounted obstruction A children, showed the

E​ D​
number the observed Series- ​ This anywhere anus. gloves. better increase for of

A​
occurred estimates ​M​ (31-33) An factors most risk rates (17,18,23) ​ along estimated
 N​ U​
the factors of ​ are in Shunt an of risk shunt five the infection shunt prematurity, ​ of of

S​ C​
migration Shunt failures catheter 14.7% shunt each ​ shunt infections ​ rate of malfunction

R​
infections of infection in post-operative the pathway ​ through of this shunt 3.5% initially with

IP​ T​
series. have the have placement long-term and and per ​ anus placed Other

cause shunt
most been been
CSF
is
in some current literature. This may occur in disconnected parts,
entire shunt ware, though rarely. (34,35)
Other series reported variable rates, and this is a common paediatric complication. (4,14, 19)
Suggested remedies includes use of bulbous shunt valves or reservoir, angulated shunt
connectors, a bur hole cover, and small frontal bur hole with a cruciate durotomy, pericranial
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anchorage of the shunt connector, patient’s selection, and surgeon experience. Image-guided and
endoscopic-assisted shunt placement procedures are the other strategies to minimise migration
and obstruction. (20,36-38)
The Chhabra shunt system is a unitised shunt with cylindrical valve-reservoir used in the Korle Bu
Teaching Hospital; because of its low cost and ease However, earlier comparative series did not
find significant differences these simple systems and the Codman-Hakim micro-precision shunts or
(11,39)
Rare ​Few as with ventriculoatrial ​Mortality ​The progression nine number ​Study C ​ SF patients
mortality (24.30%) ​complications ​the ​Limitations ​of ascites peritonitis deaths and in rate and

C​
shunts (40), our shunt ​A​ and for series for ​ pseudocysts and other sepsis.The because

C​ E​ P​
non-shunt the ​ developed the related study ​ of shunts ​ number persistent and related

T​ E​
terminations was ​ some peritonitis. externalized 4.59% ​ of complications of CSF

D​
censored ​ the over with ascites. more Two ​ M​ and the events death rare of

A​ N​
three-year was then the ​ complications frequently for five patients completely
U​ S​
shunt-related (6.90%). period. ​ 13

C​ RI​ P​ T
in adjustable of ​ outcomes availability. components ​ systems. ​ between ​

and is
of shunt surgery such
had laparotomies to deal
removed. Two had
due to primary disease
complications was
These represent the
Most comprehensive studies on VPS complications were followed over a ten-year
period. As Kang and colleagues stated clearly, the causes of shunt failure are time-
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related, with different onsets and sufficiently long periods of follow-up are needed to
detect failure. This is difficult in a region of poor health infrastructure and poverty such
as ours. Our median follow-up was 11.6 months (range 0-36 months).
Recommendations/Interventions
​ 4 ​Peri-operative Hydrocephalus related persons completing procedure meticulous
1. 2. 3. 1

C​
Congenital The patients Well-designed looked and ​ A​ in use the ​ complications. into. in
 C​
to of Cure done the obviate endoscopic ​ surgical and the Examples operating protocols

E​ P​
systems Clinical tumoural ​ Hospital in procedure the shunt-related ​ techniques; operating

T​
Choux third are for ​ Research theatre aimed in aetiologies found in comprehensive Uganda.

E​ D​
ventriculostomy under and at ​ to and theatre; complications. in reducing NetWork

colleagues 4-four 40minutes, community- patient were ​ M​ careful including common

A​ N​
follow-up shunt hair Group may suggested ​ having medical cleaning.(6)
 U​ S​
based infection prove (22) ​ an indications of experienced the support ​ are limiting the

C​ R​
useful assessment such procedure vital ​ patients groups in for as ​ the in treating those

I​ P​
shunt reducing neurosurgeon, number should of ​ be ​ in patient, of insertions.

T
Tanzania the these ​

the
be of shunt-
first
Conclusion:
The most common indications for shunt insertions were tumoural and congenital lesions and that
may offer us benefit with the use of endoscopic third ventriculostomy.
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Comprehensive follow-up of these patients may give a better picture of the magnitude of the
problem; hence the need for properly designed prospective studies to improve the current
outcomes.
Conflicts ​None to declare
of Interest
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A​
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M​
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Acknowledgments

We are grateful to the entire staff of the neurosurgical unit of the Korle-Bu Teaching Hospital

C​ C​
and Gyimah also for to all his of help ​A​ the with ​ patients ​ data who

E​ P​ T​ E​ D​
collection ​ consented ​ and ​ to analysis. ​ be part ​M​ of
 A​ N​ U​ SC​ RI​ PT ​
this ​ study. ​ Special ​ thanks ​ also ​ to Mr

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A​ East ​ Afr ​ Med ​ J. 1997;74(4):263–266. ​

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Table 1: Age of patients
Age of patients < 18 yrs Adults (> 18 yrs) Age of patients ​Frequency ​< 6 months ​23 ​6 - 12
months ​37 ​1 - 6 yrs ​34 ​7 - 12 yrs ​12 1
​ 3 - 17 yrs ​3 109

CCEPT​ E​
A​ Percentage Frequency ​ 21.1 33.9 31.2 11.0 109 124
 D ​ A​ N​ U​ S​
100 2.8 15 ​ M​ Mean ​ 5.35 ​ Percentage ​ 87.9 12.1 100

C​ RIPT
1.264 S.D ​

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Table 2: Shunt complications
Shunt Complications

CCE​ P​ TED
Frequency Percentage ​Yes No ​ A​ 109 ​ 37 72 ​

ANUS​ CRIPT
M​ 33.9 66.1 100 ​

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Table 3: Duration before shunt related complications started
Duration before complications started < 3 months 4 - 6 months 6 - 12 months 13 - 24

CC​ E​
months 25 - 36 months ​ A​ Frequency ​ 15 37 8 9 3 2
 PTED ​
Percentage 21.6 40.5 24.3

ANU​ SCR​ I​ PT
100 8.1 5.4 ​M​ Mean 8.01 ​ 3.219 ​ S.D ​

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Table 4: Survival distribution between shunt and non – shunt complications

Survival distribution Comparisons of

control variable: complications Overall
comparisons a​ ​Wilcoxon (Gehan) Statistic
48.679 a. comparisons are exact

CCEP
A​
 TED NUSC​
.000 sig

A​ RIPT
M​ df 1

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Table 5: Survival table ​Case Processing Summary

12.8% 6.9%

Type of complication Total N N of Events

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Censored

Shunt complication 37 28 Non-shunt complication 72 67 Overall 109

95

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A​ N​
N​M​ 14 9 5 ​ Percent ​ 24.3%

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Table 6: Mean and Median for survival time:
Means and Medians for Survival Time

C​
Type of complication Shunt Non-shunt Overall a. Estimation complication complication is limited ​ A​ to ​ Estimate the

CE​ P​ T​ E​
18.956 16.273 9.000 largest ​ Std. survival ​ 1.553 1.640 1.320 Error ​ time MeanLower 95% ​ if

D​ A​
it a​ ​is Bound 15.742 13.687 ​ Confidence 5.956 censored. ​M​ Upper Interval ​ Bound 12.044 22.170

NU​ SC​ R​ I​
18.860 ​ Estimate 23.000 13.000 7.000 ​ Std. 5.111 4.255 Error ​ .581 ​ Median Lower

P​ T
95% ​

Bound 12.983 Confidence 5.862 4.660 Interval Upper Bound

8.138
33.017
21.340
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Table 7: Overall comparisons
Overall Comparisons
3.443 1 ​
Chi-Square df Log Rank (Mantel-Cox) 10.596 1 Breslow (Generalized Wilcoxon) ​ Tarone-Ware 6.773 1 The vector of trend
weights is -1, 1. This is the default.

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.009 ​

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Figure 1: Types of shunt complications
Types of shunt complications

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13.5 13.5 13.5

8.1 8.1
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Figure 2: Etiology of hydrocephalus
Etiology of hydrocephalus
 25 201510524.2
0​
16.9 16.9
13.7

9.7 ​8.9

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A​
A​ NU​ S​ CR​
M​ 4​ 2.4 ​ 2.4 ​ 0.8

IPT
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Figure 3: Survival function of shunt and non – shunt related complications in patients.

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List Of Abbreviations
VPS ventriculoperitoneal shunt

C​
CSF SPSS IBM ICU cerebrospinal Statistical International Intensive ​ A​ Care

C​ E​ P​ T​ E​ D
Package Business fluid ​ Unit ​ for ​ the Machines ​ Social ​

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Sciences ​M​
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Highlights
➢ ​The most common cause of post-infective hydrocephalus by the study was pyogenic
bacterial meningitis.

➢ ➢ ➢ ​Most compared Infection The progression mortality Shunt ​ A​ was to – and non
C​ C​ E​
related identified rate shunt – ​ for shunt complications ​ the sepsis. to related study

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be the ​ was complications major ​ usually 4.59% ​

AN​
type with occurred ​ M​ of which shunt death ​ between – occur frequently related

U​ S​ C​ R​ IP​
after ​ 4 complication and 18 due ​ 6 months to months ​ primary ​ by

as

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the ​

disease
study.