Hydrocephalus is now the most commonly treated problem in pediatric neurosurgery and the cerebrospinal fluid (CSF) shunt is the neurosurgical procedure with the highest incidence of complica-tions. Complications in CSF shunting have re-ceived considerable attention and many articles have been written about them, yet controlled clini-cal trials are lacking in many areas of management. Consequently many management decisions are reached on the basis of empiric observation or past experience. The purpose of this article is to high-light our experience in complications and revision rate of CSF shunting (1,2).

Materials and Methods
Data obtained from the fıles of the patients were summarized in Table 1. Ali of the patients were operated on by the same surgeon and as a fırst case in the operating room. 10 patients undervvent ventriculoperitoneal shunting with, the diagnosis of hydrocephalus. During two years’ follow up period 12 revisions have been performed because of shunt malfunction. Half of the patients were female. 4 patients were in the neonatal period when they were operated on. One of the patients had been shunted in another neurosurgery center. This patient have been sent to our clinic with the diagnosis of sub-dural effusion, liver abscess and sepsis secondary to ventriculoperitoneal shunting. He died during the follow up in our clinic. Three patients died because of the reasons other than hydrocephalus after their treatment were completed and they were dis-charged. Half of the hydrocephalic patients in our series had also spinal dysraphism and operated on for meningomyelocele or meningocele. All but two of our patients were operated on once in their fol-low up period for shunt malfunction. The two pa-tients were operated on twice for shunt malfunction and one of the had hydrocephalus secondary to tu-berculosis meningitis.

Discussion
Hydrocephalus has been the focus of more dedicated study and investigation than perhaps any other condition afflicting the human nervous system. For many centuries patients with hydro-cephalus had limited expectations for survival. With modern cerebrospinal fluid (CSF) shunts, normal learning and intelligence is now possible and patients are able to enjoy full participation in all facets of life (1,3). Diversion of CSF to extracranial absorption reservoirs was first attempted in the last century. After usage of many kind of diversion techniques in the first half of this century early ventriculoatrial shunts were successful, but diversion to the peritoneal cavity has evolved as the treatment of choice for hydrocephalus (2,4). Even though di-agnosis and follow up of patients with hydro-cephalus have been facilitated by the imaging rev-olutions of the past two decades: the availibility of high resolution ultrasound, computed tomography, and magnetic resonance imaging. The development of effective shunts represents a landmark achieve-ment in neurosurgery. The natural history of un-treated hydrocephalus is disabling disfigurement and retardation that heralded a bleak future for a great majority of infants with hydrocephalus before the development of effective shunts. However, this success has been tempered by a high incidence of serious complications that accompany the diversion of CSF. Many of these complications results in the shunt displacement and renewal (5-7). Some of the complications which result in shunt revision are proximal obstruction, valve related obstructions, distal or peritoneal cathater obstructions, internal and external obstructions, overdrainage, pneumo-cephalus, and rarely metastases.

Obstruction
Eventhough shunt obstruction is frequently cit-ed as the most common source of shunt failure, there are relatively few reports that focus on shunt obstruction. Shunt obstruction can be considered in 3 categories (5).
1) proximal obstruction (ventricular catheter): It is the most common site of obstruction. It almost accounts half of the ventriculoperitoneal shunt re-visions. Choroid plexus, brain debris, fibrin and clotted blood are most frequent causes for ventric-ular catheter obstruction. Disconnection can serve as a cause of ventricular catheter dysfunction. As with any other portion of occluded shunt, the treat-ment of an occluded ventricular catheter involves removal and replacement with a functional catheter.
2) distal obstruction (peritoneal catheter): With modern ventriculoperitoneal shunts, distal obstruc-tion is seen principally in the settings such as; im-proper placement at the time of initial shunt place-ment, low-grade infection with intraabdominal loc-ulation or pseudocyst formation and disconnection, migration, or withdrawal of the catheter from the peritoneum.
3) valve obstruction. The greatest propensity for valve occlusion ought to involve those cases where CSF protein is elevated. Yet there appear to be few reported data to support this commonly held belief that high CSF protein is predictive of valve failure.
Infection of CSF shunts is a common compli-cation that often has devastating consequences. The incidence ranges from 3% to 29% and the mortali-ty from shunt related ventriculitis is 30% to 40%. Success in the treatment is often difficult, requires extended treatment. Furthermore, seizures, cogni-tive deficiences, and psychomotor retardation have been noted in patients who are succesfully treated. Overdrainage which is another complication in ventriculoperitoneal shunting, is seen in 10% to 12% of all shunted patients. It may cause subdural hematoma, premature suture closure, silvian aquaduct stenosis and slit ventricle syndrome (8-12).

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