Complications of ventriculoperitoneal shunting: Is there further need of more evidence-based approach to care?

Background and Objectives

Despite extensive research on VP (ventriculoperitoneal) shunt-related problems leading to development of evidence-based recommendations, several published papers reporting complications (especially rare ones) still suggest disparities in management approach. The authors sought to broadly quantify the level of evidence on approach to care documented in the literature and to characterize these differences in the light of evidence-based practice.

Methods

A systematic review of the English literature was performed in accordance with PRISMA guidelines to evaluate the levels of evidence across published clinical studies on management of various VP shunt complications reported in the literature. Selected articles on VP shunt complications were subgrouped according to their respective ICD- 10 code classifications and level of evidence documented.

Results

A total of 1,983 papers were reviewed, of which 171 met criteria of inclusion. Nine studies were classified as level III evidence, the remaining reached level IV evidence. Apart from BASICS multicenter randomized trial, there were no other level I or level II studies. Besides guidelines by the HRCN (i.e. Hydrocephalus Clinical Research Network) and the Infectious Diseases Society of America as well as 3 papers suggesting algorithms for treatment, there were no other standardized protocols on management of VP shunt complications identified.

Conclusion

With only few universally accepted guidelines, the superiority of one technique over the other in the management of most VP shunt complications still remains unclear in the context of the available evidence. This highlights the imperative for consensus statements possibly generated through multicentre cross-continental structured surveys to unify various treatment paradigms for uniformity of approach to care.