Postoperative Complications and Outcome in 14 Dogs Treated for Hydrocephalus by Ventriculoperitoneal Shunting
Ventriculoperitoneal (VP) shunting is indicated for the treatment of hydrocephalus independently of the underlying cause. Outcome and postoperative complications following this procedure have been reported in a limited number of cases in the veterinary literature to date. The purpose of this study was to describe the outcome, type and rate of complications in 14 dogs presented with severe neurological signs secondary to obstructive hydrocephalus and treated by VP shunting (Medronic PS Medical Snap Shunt Assemblies).
The clinical database (2001-2006) was searched for dogs that underwent VP shunting. Inclusion criteria were complete medical record, progressive CNS signs unresponsive to medical treatment, normal metabolic profile, negative antibody titers and/or CSF PCR for Toxoplasma gondii, Neospora caninum and Canine Distemper virus, MRI scan of the brain, VP shunting and detailed follow-up. Fourteen dogs met the inclusion criteria. There was no breed predisposition. Mean age was 5 years (6 months to 11 years). Most common clinical signs at presentation included lethargy, obtundation, seizures and compulsive walking. Obstructive hydrocephalus was diagnosed as congenital in 5 dogs and acquired (intraventricular tumors, intraventricular hemorrhage, and inflammatory disease) in 9. Four dogs developed complications 1 week to 17 months postoperatively. Complications included ventricular catheter migration, infection, shunt underdrainage, kinking of the peritoneal catheter, valve fracture and skin necrosis of the abdomen. Three dogs underwent 1 or more successful revision surgeries and 1 dog was treated with antibiotics. Of the 5 dogs diagnosed with congenital hydrocephalus, 3 were euthanized due to relapse of clinical signs (severe seizures) 2 to 9 months following surgery, 1 dog was euthanized due to renal failure 12 months after surgery, and 1 dog was still alive at the time of writing 16 months postoperatively. Of the 9 dogs with acquired hydrocephalus, 7 were euthanized due to lack of improvement/worsening of the neurological signs 2 days to 19 months postoperatively (mean 8.6 months), 1 was euthanized due to cardiac failure 10 months postoperatively and 1 was still alive at the time of writing 6.5 years postoperatively. All but 1 dog were discharged within 1 week of surgery, showed a significant neurological improvement and regained a good quality of life. Thirteen dogs were alive at 1 month postoperatively, nine dogs were alive 3 months postoperatively, and 6 dogs were alive 12 months postoperatively.
Ventriculoperitoneal shunting was successful in relieving the neurological signs and improving quality of life of the majority of the dogs. Several postoperative complications occurred in 29% of dogs which resolved following revision surgery and/or medically.