Analysis of factors affecting ventriculoperitoneal shunt survival in pediatric patients
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Management of hydrocephalus with insertion of ventriculoperitoneal (VP) shunt is associated with significant complications in both adult and pediatric patients. These may be more common in developing countries due to poor economic conditions and a dearth of available resources. We report a 6 years' experience with VP shunt insertion in pediatric patients from a developing country, focusing particularly on factors affecting shunt failure.
Patients aged below 15 years, who had undergone insertion of VP shunts for hydrocephalus during the years 2006 to 2011, were included. A retrospective analysis of shunt survival was performed using Kaplan–Meier curves and Logrank (Cox–Mantel) test.
Among the total 113 patients, the most common etiologies of hydrocephalus were congenital hydrocephalus (19.5 %), brain tumors (14.2 %), and postcranial surgery (13.3 %). Overall shunt failure at a mean follow-up of 11 months was 23 % with the median time to first shunt failure being 68 days. Shunt survival was worse in patients with meningitis (p = 0.024), aqueductal stenosis (p = 0.008), postcranial surgery hydrocephalus (p = 0.006), Caesarean mode of delivery (p = 0.036), congenital abnormalities (p = 0.031), and a past history of surgical excision of mass lesion (p = 0.044).Frequency of shunt failure was also significantly affected by the location of brain tumor (p = 0.015) and prematurity (p = 0.015).
Premature infants still have a higher rate of shunt failure. Patients with meningitis, aqueductal stenosis, postcranial surgery hydrocephalus, congenital abnormalities, and a past history of surgical excision of mass lesion may have early shunt failure. However, the frequency of shunt failure that we observed (23 %) was much lower than that quoted earlier in the literature and this may be a consequence of rigorous periodic evaluation of patients with VP shunt in situ.
KeywordsHydrocephalus Ventriculoperitoneal shunt Cerebrospinal fluid shunt Shunt survival Shunt complication
The authors would like to acknowledge Dr. Ayesha Arshad (Resident Neurosurgery) for her contribution in the preparation of the questionnaire for this study.
Conflict of interest
- 3.Borgbjerg BM, Gjerris F, Albeck MJ, Hauerberg J, Borgesen SE (1995) Frequency and causes of shunt revisions in different cerebrospinal fluid shunt types. Actaneurochirurgica 136:189–194Google Scholar
- 9.Crnich CJ, Safdar N, Maki DG (2003) Infections associated with implanted medical devices. Antibiotic and chemotherapy: anti-infective agents and their use in therapy 8: 575–618Google Scholar
- 11.Di Rocco C, Marchese E, Velardi F (1994) A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus. Cooperative survey of the 1991–1992 Education Committee of the ISPN. Child's nervous system: ChNS: official journal of the International Society for. Pediatr Neurosurg 10:321Google Scholar
- 13.Drake JM, Sainte-Rose C (1995) The shunt book. Blackwell, CambridgeGoogle Scholar
- 15.Enger P, Svendsen F, Wester K (2003) CSF shunt infections in children: experiences from a population-based study. Actaneurochirurgica 145:243–248Google Scholar
- 21.Gutiérrez-González R, Boto GR, Pérez-Zamarrón A (2011) Cerebrospinal fluid diversion devices and infection. A comprehensive review. Eur. J Clin Microbiol Infect Dis 1–9Google Scholar
- 27.Kinasha ADA, Kahamba JF, Semali IT (2005) Complications of ventriculoperitoneal shunts in children in Dar es Salaam. East Cent Afr J of Surg 10:55–59Google Scholar
- 31.Liptak GS, Masiulis BS, McDonald JV (1985) Ventricular shunt survival in children with neural tube defects. Actaneurochirurgica 74:113–117Google Scholar
- 36.Mwang'ombe NJM, Omulo T (2009) Ventriculoperitoneal shunt surgery and shunt infections in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi. East Afr Med J 77Google Scholar
- 44.Pirotte BJM, Lubansu A, Bruneau M, Loqa C, Van Cutsem N, Brotchi J (2007) Sterile surgical technique for shunt placement reduces the shunt infection rate in children: preliminary analysis of a prospective protocol in 115 consecutive procedures. Childs Nerv Syst 23:1251–1261PubMedCrossRefGoogle Scholar
- 48.Rashid QTA, Salat MS, Enam K, Kazim SF, Godil SS, Enam SA, Iqbal SP, Azam SI (2012) Time trends and age-related etiologies of pediatric hydrocephalus: results of a groupwise analysis in a clinical cohort. Childs Nerv Syst 1–7Google Scholar