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Association between ventricular shunt catheter calcifications and the development of shunt fracture

  • M. Azfar Siddiqui
  • Anna K. Hardy
  • Philippe A. Mercier
  • Shannon G. FarmakisEmail author
Original Article
  • 25 Downloads

Abstract

Background

Calcifications along ventricular catheters have been associated with shunt fractures although it is unknown whether their development predicts whether and when the shunts will fracture.

Objective

To determine whether extracranial calcifications found on a radiographic shunt series predicts whether a patient will experience a shunt catheter fracture or complication.

Materials and methods

A retrospective review was performed of pediatric patients with a ventricular shunt placed before 18 years of age and radiographic shunt series. Two thousand, six hundred and thirty shunt series in 523 patients (301 male) were reviewed to identify the development of calcifications around the catheter and fracture. Fifty-one patients were excluded for preexisting calcifications with shunt fracture. (48) Absence of shunt (2) or age (1). Analysis included descriptive statistics, odds ratio and chi-square test results.

Results

Four hundred seventy-two patients were included. Of the 59 shunts in 58 patients that developed calcifications, 23 went on to fracture (39%). Forty shunts without calcification in 37 patients developed fractures. There is a significant positive association between calcification and fracture (Χ2=39.1, P<0.01). It is 6.12 times more likely that a fractured shunt had calcifications compared to a non-fractured shunt having calcifications. Calcifications appeared within an average of 9 years, 10 months (range: 4-14 years) after shunt insertion. Shunt fractures occurred within an average of 5 years, 2 months (range: 6 months-9 years) after the appearance of calcifications with a median patient age of 14.6 years. Nearly all fractures were at or adjacent to the calcifications, most commonly in the neck (17/23; 73.9%).

Conclusion

Shunt calcification represents a significant risk for catheter fracture in the pediatric population. Early intervention or closer interval follow-up may be indicated in those found to have calcifications.

Keywords

Calcification Pediatric Fracture Radiography Ventricular shunt 

Notes

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    Boockvar JA, Loudon W, Sutton LN (2001) Development of the Spitz-Holter valve in Philadelphia. J Neurosurg 95:145–147CrossRefGoogle Scholar
  2. 2.
    Salim AD, Elzain MA, Mohamed HA, Ibrahim Zayan BE (2015) Shunt tube calcification as a late complication of ventriculoperitoneal shunting. Asian J Neurosurg 10:246–249CrossRefGoogle Scholar
  3. 3.
    Paff M, Alexandru-Abrams D, Muhonen M, Loudon W (2018) Ventriculoperitoneal shunt complications: a review. Interdisc Neurosurg 13:66–70CrossRefGoogle Scholar
  4. 4.
    Yamamoto S, Ohno K, Aoyagi M et al (2002) Calcific deposits on degraded shunt catheters: long-term follow-up of V-P shunts and late complications in three cases. Childs Nerv Syst 18:19–25CrossRefGoogle Scholar
  5. 5.
    Lee L, Low S, Low D et al (2016) Late pediatric ventriculoperitoneal shunt failures: a Singapore tertiary institution's experience. Neurosurg Focus 41:E7CrossRefGoogle Scholar
  6. 6.
    Reddy GK, Bollam P, Caldito G (2014) Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg 81:404–410CrossRefGoogle Scholar
  7. 7.
    Stone JJ, Walker CT, Jacobson M et al (2013) Revision rate of pediatric ventriculoperitoneal shunts after 15 years. J Neurosurg Pediatr 11:15–19CrossRefGoogle Scholar
  8. 8.
    Dave P, Venable GT, Jones TL et al (2019) The preventable shunt revision rate: a multicenter evaluation. Neurosurgery 84:788–798CrossRefGoogle Scholar
  9. 9.
    Boch AL, Hermelin E, Sainte-Rose C, Sgouros S (1998) Mechanical dysfunction of ventriculoperitoneal shunts caused by calcification of the silicone rubber catheter. J Neurosurg 88:975–982CrossRefGoogle Scholar
  10. 10.
    Kural C, Kirik A, Pusat S et al (2012) Late calcification and rupture: a rare complication of ventriculoperitoneal shunting. Turk Neurosurg 22:779–782Google Scholar
  11. 11.
    Dean AG, Sullivan KM, Soe MM (2013) OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version 3.01. www.OpenEpi.com. Accessed 17 Dec 2018
  12. 12.
    Irving IM, Castilla P, Hall EG, Rickham PP (1971) Tissue reaction to pure and impregnated silastic. J Pediatr Surg 6:724–729CrossRefGoogle Scholar
  13. 13.
    Echizenya K, Satoh M, Murai H et al (1987) Mineralization and biodegradation of CSF shunting systems. J Neurosurg 67:584–591CrossRefGoogle Scholar
  14. 14.
    Stannard MW, Rollins NK (1995) Subcutaneous catheter calcification in ventriculoperitoneal shunts. AJNR Am J Neuroradiol 16:1276–1278Google Scholar
  15. 15.
    Baird C, O’Connor D, Pittman T (1999) Late shunt infections. Pediatr Neurosurg 31:269–273CrossRefGoogle Scholar
  16. 16.
    Bakhsh A (2011) CSF shunt complications in infants–an experience from Pakistan. Pediatr Neurosurg 47:93–98CrossRefGoogle Scholar
  17. 17.
    Drake JM, Kestle JR, Milner R et al (1998) Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43:294–303CrossRefGoogle Scholar
  18. 18.
    Miranda P, Simal JA, Menor F et al (2011) Initial proximal obstruction of ventriculoperitoneal shunt in patients with preterm-related posthaemorrhagic hydrocephalus. Pediatr Neurosurg 47:88–92CrossRefGoogle Scholar
  19. 19.
    Shah SS, Hall M, Slonim AD et al (2008) A multicenter study of factors influencing cerebrospinal fluid shunt survival in infants and children. Neurosurgery 62:1095–1103CrossRefGoogle Scholar
  20. 20.
    Çakir E, Kuzeyli K, Usul H et al (2004) Shunt dysfunction due to calcification of a ventriculo-peritoneal shunt: a case report. J Clin Neurosci 11:210–211CrossRefGoogle Scholar
  21. 21.
    Agrawal A, Rao GM (2014) Letter to the editor. Subcutaneous shunt catheter calcification: an uncommon cause of shunt failure. Saudi J Med Med Sci 2:125–126CrossRefGoogle Scholar
  22. 22.
    Elisevich K, Mattar AG, Cheeseman F (1994) Biodegradation of distal shunt catheters. Pediatr Neurosurg 21:71–76CrossRefGoogle Scholar
  23. 23.
    Aldrich EF, Harmann P (1990) Disconnection as a cause of ventriculoperitoneal shunt malfunction in multicomponent shunt systems. Pediatr Neurosurg 16:309–312CrossRefGoogle Scholar
  24. 24.
    Wu Y, Green NL, Wrensch MR et al (2007) Ventriculoperitoneal shunt complications in California: 1990 to 2000. Neurosurgery 61:557–563CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologySt. Louis University School of MedicineSt. LouisUSA
  2. 2.Department of NeurosurgerySSM Health Cardinal Glennon Children’s HospitalSt. LouisUSA
  3. 3.Department of Radiology St. Louis University School of MedicineSSM Health Cardinal Glennon Children’s HospitalSt. LouisUSA

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