Outcome of Ventriculoperitoneal Shunt insertion at Myungsung Christian Medical Centre in Ethiopia

Background: We investigated the feasibility of shunt insertion procedures with acceptable short-term outcomes in Ethiopia, and to identify factors associated with good and bad outcomes.
Methods: This is a hospital based prospective cohort study of outcome of ventriculoperitoneal shunt insertion at Myungsung Christian Medical center (MCM), Addis Ababa, Ethiopia in the period between January 2011 and December 2012. Medical records were reviewed in a structured questionnaire prepared for this purpose. Epidemiological data, head circumference, clinical investigations, etiology of the hydrocephalus, details of the ventriculoperitoneal(VP) shunt insertion, outcome by the end of 6 months, morbidity and mortality data were collected. Outcomes were graded as good, fair, or poor, according to head circumference, anterior fontanels status, visual, motor, and seizure criteria. Difference in proportions was examined using Chi-square test.
Results: The Authors review141 VP shunt insertions in 114 patients≤ 12 years of ageatMCM, 61(53.5%) were male and 46(46.5%) female. The median age was 3 months (range 0.3-144); the mean head circumference at presentation was 50.4 ± 10.1cm (range, 34-106). The commonest causes of hydrocephalus were spina bifida (42.3%) and post infectious (20.2%). Early complications following surgery were seen in 65(58.0%) patients. The commonest complication was mechanical failure in 54 (48.2%) patients, under shunting constituted 83.3% of the mechanical shunt failure, shunt infection being 7%. Follow-up was available in 75.4% of children, with a mean follow-up period of 6.8 ± 7.2 months (range 1-36). In-hospital mortality was 1.8%. The overall shunt function rate at last visit was 88.3%, head circumference ≥ 50 cm had significant early complication compared to those with ≤ 50 cm. Age and Sex were not significantly correlated to the occurrence of complications and outcomes.
Conclusion: Spina bifida was main etiological cause of hydrocephalus. Our study has documented good outcomes at 12 months follow-up period for VP shunt insertion with acceptable early complication rates. However, child ren with a head circumference greater than 50 cm had significant early complication (p=0.028). Given the availability of fully subsidized VP shunts in a country with enormous number of hydrocephalic children, shunts will continue to play a pivotal role in the management of hydrocephalus in Ethiopia.