Use of the Malawi shunt in the treatment of obstructive hydrocephalus in children.

In 1992, as a result of shortage of conventional shunts we devised our local Malawi shunt made from siliconised rubber tubing and right angled metal connector between its ventricular and peritoneal parts, like the Harare shunt from which it differs in a few ways. Between 1992 and 1995, eighty four Malawian hydrocephalic children underwent ventriculoperitoneal shunting with the Malawi shunt. The operation was routinely performed by the consultant assisted by residents. Parietal burr hole was made to introduce the ventricular catheter and the peritoneal catheter inserted by open surgery through an incision between the subcostal margin and the umbilicus. The average hospital stay after operation was eleven days. The shunt functioned satisfactorily immediately after insertion in 80% of cases; in the rest there was hyper-drainage which led to cranial collapse. The other complications noted included blockage ten at the proximal end and six at the distal; abdominal wound rupture two cases; shunt disconnection two cases and infection, one case. The blocked shunts were all revised successfully. The cases of cranial collapse recovered without neurological deficits but retained varying degrees of mild to moderate acquired craniostenosis.