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). CONCLUSIONS 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.