**4.3 Shunts**

Shunting CSF is one of the common procedures done routinely in neurosurgical wards, different variants of shunting are used for divergence of the CSF and they all include implantation of foreign bodies, therefore having similar high infection rates postoperatively. As V-P shunts are the most common used variant of the CSF divergence, we will be discussing only the complications of V-P shunts. The V-P shunt infection occurs at a rate of 5–10%, *Staphylococcus epidermidis* accounts for the majority of infections (60%) as well as *Staphylococcus aureus* (30%). The shunt

#### **Figure 5.**

*Contrast enhancement on T1 scans (upper images) can be seen, rim enhancement and hypointense central compartment in the cerebellar region reveals multiplex abscess formation (upper left image). Contrast enhancement and dilation of aqueduct is seen, and this is indicative of intraventricular involvement of inflammation (upper right image). Lower pictures show regression of the inflammatory lesions after aggressive antibiotic treatment and removal of the V-P shunt system. Minimal contrast enhancement is seen between the two cerebellar hemispheres (lower left image).*

infections usually occur within the first 6 months of implantation, the first month having the highest probability [11]. Factors such as contamination of shunt with skin flora during implantation, leakage, improper wound closure and ongoing intracerebral or abdominal inflammation at the time of surgery are the common causes of V-P shunt infections within the first month of implantation, long term complications of shunts are usually due to secondary infections. Peritonitis can be a severe complication of V-P shunt infection as well as a source for V-P shunt infection. Odontogenic infections often cause intracerebral inflammation and with the presence of V-P shunts, this can cause shunt failure and serious complications. **Figure 5** shows a case of V-P shunt infection after 3 years of implantation due to an ongoing untreated dental infection which had caused severe ventriculitis and multiple abdominal infected granulomas.
