Ventriculoperitoneal (VP) shunting remains the most frequently performed neurosurgical procedure for the long-term management of hydrocephalus, yet complication and revision rates remain high despite advances in valve technology and peri-operative care. Contemporary adult and mixed-age series report overall shunt revision rates of approximately 20–40% within the first 1–2 years after implantation and even higher cumulative failure rates over longer follow-up . Shunt infection and mechanical failure are consistently identified as the leading causes of morbidity and healthcare utilization .

This chapter provides an evidence-based, temporally structured overview of VP shunt complications based on literature predominantly from 2020–2025, complemented by key earlier studies where necessary. Complications are discussed along the pre-operative, intra-operative, and post-operative phases, and are further organized by anatomical compartment (cranial, hardware-related, and abdominal). We summarize current data on risk factors, incidence, clinical presentation, diagnostic strategies, and management algorithms for shunt infection, hemorrhagic and mechanical complications, over- and under-drainage, and abdominal events such as pseudocyst formation and visceral perforation. Particular emphasis is placed on standardized preventive strategies, including the use of antibiotic-impregnated catheters, strict insertion checklists, minimally invasive distal catheter techniques, and the concept of a “Shunt Bundle” as a quality-improvement tool .