Skip to main content

Advertisement

Log in

Shunt revision requirements after posthemorrhagic hydrocephalus of prematurity: insight into the time course of shunt dependency

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

Intraventricular hemorrhage (IVH) is a common affliction of preterm infants and often results in posthemorrhagic hydrocephalus (PHH). These patients typically eventually require permanent CSF diversion and are presumed to be indefinitely shunt-dependent. To date, however, there has been no study of long-term shunt revision requirements in patients with PHH.

Methods

We analyzed retrospectively collected data for 89 preterm patients diagnosed with grades III and IV IVH and PHH at our institution from 1998 to 2011.

Results

Sixty-nine out of 89 patients (77.5 %) underwent ventriculoperitoneal (VP) shunt placement, and 33 (47.8 %) required at least one shunt revision and 18 (26.1 %) required multiple revisions. The mean ± standard deviation follow-up time for shunted patients was 5.0 ± 3.3 years. The majority of early failures were due to proximal catheter malfunction, while later failures were mostly due to distal catheter problems. There was a significant difference in the number of patients requiring revisions in the first 3 years following initial VP shunt insertion compared after 3 years, with 28 revisions versus 10 (p < 0.004). In 8 out of 10 patients who underwent shunt revisions after 3 years, evidence of obstructive hydrocephalus was found on imaging either in the form of an isolated fourth ventricular cyst or aqueductal stenosis.

Conclusions

Our results suggest that in a distinct subset of patients with PHH, obstructive hydrocephalus may develop, resulting in long-term dependence on CSF diversion. Further study on the factors associated with long-term shunt dependence and revision requirements within the PHH group is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Alan N, Manjila S, Minich N, Bass N, Cohen AR, Walsh M, et al. (2012) Reduced ventricular shunt rate in very preterm infants with severe intraventricular hemorrhage: an institutional experience. J Neurosurg Pediatr 10:357–364

    Article  PubMed  Google Scholar 

  2. Beez T, Sarikaya-Seiwert S, Bellstadt L, Muhmer M, Steiger HJ (2014) Role of ventriculoperitoneal shunt valve design in the treatment of pediatric hydrocephalus—a single center study of valve performance in the clinical setting. Childs Nerv Syst 30:293–297

    Article  PubMed  Google Scholar 

  3. Berry JG, Hall MA, Sharma V, Goumnerova L, Slonim AD, Shah SS (2008) A multi-institutional, 5-year analysis of initial and multiple ventricular shunt revisions in children. Neurosurgery 62:445–453 discussion 453–444

    Article  PubMed  Google Scholar 

  4. Brouwer A, Groenendaal F, van Haastert IL, Rademaker K, Hanlo P, de Vries L (2008) Neurodevelopmental outcome of preterm infants with severe intraventricular hemorrhage and therapy for post-hemorrhagic ventricular dilatation. J Pediatr 152:648–654

    Article  PubMed  Google Scholar 

  5. Brouwer AJ, van Stam C, Uniken Venema M, Koopman C, Groenendaal F, de Vries LS (2012) Cognitive and neurological outcome at the age of 5–8 years of preterm infants with post-hemorrhagic ventricular dilatation requiring neurosurgical intervention. Neonatology 101:210–216

    Article  CAS  PubMed  Google Scholar 

  6. Chittiboina P, Pasieka H, Sonig A, Bollam P, Notarianni C, Willis BK, et al. (2013) Posthemorrhagic hydrocephalus and shunts: what are the predictors of multiple revision surgeries? J Neurosurg Pediatr 11:37–42

    Article  PubMed  Google Scholar 

  7. Lazareff JA, Peacock W, Holly L, Ver Halen J, Wong A, Olmstead C (1998) Multiple shunt failures: an analysis of relevant factors. Childs Nerv Syst 14:271–275

    Article  CAS  PubMed  Google Scholar 

  8. Lee IC, Lee HS, Su PH, Liao WJ, Hu JM, Chen JY (2009) Posthemorrhagic hydrocephalus in newborns: clinical characteristics and role of ventriculoperitoneal shunts. Pediatr Neonatol 50:26–32

    Article  PubMed  Google Scholar 

  9. Levy ML, Masri LS, McComb JG (1997) Outcome for preterm infants with germinal matrix hemorrhage and progressive hydrocephalus. Neurosurgery 41:1111–1117 discussion 1117–1118

    Article  CAS  PubMed  Google Scholar 

  10. Limbrick Jr DD, Mathur A, Johnston JM, Munro R, Sagar J, Inder T, et al. (2010) Neurosurgical treatment of progressive posthemorrhagic ventricular dilation in preterm infants: a 10-year single-institution study. J Neurosurg Pediatr 6:224–230

  11. McGirt MJ, Wellons 3rd JC, Nimjee SM, Bulsara KR, Fuchs HE, George TM (2003) Comparison of total versus partial revision of initial ventriculoperitoneal shunt failures. Pediatr Neurosurg 38:34–40

    Article  PubMed  Google Scholar 

  12. Notarianni C, Vannemreddy P, Caldito G, Bollam P, Wylen E, Willis B, et al. (2009) Congenital hydrocephalus and ventriculoperitoneal shunts: influence of etiology and programmable shunts on revisions. J Neurosurg Pediatr 4:547–552

    Article  PubMed  Google Scholar 

  13. Parker SL, Attenello FJ, Sciubba DM, Garces-Ambrossi GL, Ahn E, Weingart J, et al. (2009) Comparison of shunt infection incidence in high-risk subgroups receiving antibiotic-impregnated versus standard shunts. Childs Nerv Syst 25:77–83 discussion 85

    Article  PubMed  Google Scholar 

  14. Patwardhan RV, Nanda A (2005) Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment. Neurosurg 56:139–144 discussion 144–135

    Google Scholar 

  15. Reddy GK, Bollam P, Caldito G (2014) Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg 81:404–410

    Article  PubMed  Google Scholar 

  16. Reinprecht A, Dietrich W, Berger A, Bavinzski G, Weninger M, Czech T (2001) Posthemorrhagic hydrocephalus in preterm infants: long-term follow-up and shunt-related complications. Childs Nerv Syst 17:663–669

    Article  CAS  PubMed  Google Scholar 

  17. Robinson S (2012) Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts. J Neurosurg Pediatr 9:242–258

    Article  PubMed  Google Scholar 

  18. Sciubba DM, Noggle JC, Carson BS, Jallo GI (2008) Antibiotic-impregnated shunt catheters for the treatment of infantile hydrocephalus. Pediatr Neurosurg 44:91–96

    Article  PubMed  Google Scholar 

  19. Shah SS, Hall M, Slonim AD, Hornig GW, Berry JG, Sharma V (2008) A multicenter study of factors influencing cerebrospinal fluid shunt survival in infants and children. Neurosurgery 62:1095–1102 discussion 1102–1093

    Article  PubMed  Google Scholar 

  20. Shannon CN, Simon TD, Reed GT, Franklin FA, Kirby RS, Kilgore ML, et al. (2011) The economic impact of ventriculoperitoneal shunt failure. J Neurosurg Pediatr 8:593–599

    Article  PubMed Central  PubMed  Google Scholar 

  21. Simon TD, Riva-Cambrin J, Srivastava R, Bratton SL, Dean JM, Kestle JR (2008) Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths. J Neurosurg Pediatr 1:131–137

    Article  PubMed  Google Scholar 

  22. Simon TD, Whitlock KB, Riva-Cambrin J, Kestle JR, Rosenfeld M, Dean JM, et al. (2012) Association of intraventricular hemorrhage secondary to prematurity with cerebrospinal fluid shunt surgery in the first year following initial shunt placement. J Neurosurg Pediatr 9:54–63

    Article  PubMed Central  PubMed  Google Scholar 

  23. Smith ER, Butler WE, Barker 2nd FG (2004) In-hospital mortality rates after ventriculoperitoneal shunt procedures in the United States, 1998 to 2000: relation to hospital and surgeon volume of care. J Neurosurg 100:90–97

    PubMed  Google Scholar 

  24. Stein SC, Guo W (2008) Have we made progress in preventing shunt failure? A critical analysis. J Neurosurg Pediatr 1:40–47

    Article  PubMed  Google Scholar 

  25. Stone JJ, Walker CT, Jacobson M, Phillips V, Silberstein HJ (2013) Revision rate of pediatric ventriculoperitoneal shunts after 15 years. J Neurosurg Pediatr 11:15–19

    Article  PubMed  Google Scholar 

  26. Stone SS, Warf BC (2014) Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment for infant hydrocephalus: a prospective North American series. J Neurosurg Pediatr 14:439–446

    Article  PubMed  Google Scholar 

  27. Talamonti G, D'Aliberti G, Collice M (2007) Myelomeningocele: long-term neurosurgical treatment and follow-up in 202 patients. J Neurosurg 107:368–386

    PubMed  Google Scholar 

  28. Tuli S, Drake J, Lawless J, Wigg M, Lamberti-Pasculli M (2000) Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg 92:31–38

    Article  CAS  PubMed  Google Scholar 

  29. Wang JY, Amin AG, Jallo GI, Ahn ES (2014) Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate. J Neurosurg Pediatr 14:447–454

    Article  PubMed  Google Scholar 

  30. Warf BC, Campbell JW, Riddle E (2011) Initial experience with combined endoscopic third ventriculostomy and choroid plexus cauterization for post-hemorrhagic hydrocephalus of prematurity: the importance of prepontine cistern status and the predictive value of FIESTA MRI imaging. Childs Nerv Syst 27:1063–1071

    Article  PubMed  Google Scholar 

  31. Wellons JC, Shannon CN, Kulkarni AV, Simon TD, Riva-Cambrin J, Whitehead WE, et al. (2009) A multicenter retrospective comparison of conversion from temporary to permanent cerebrospinal fluid diversion in very low birth weight infants with posthemorrhagic hydrocephalus. J Neurosurg Pediatr 4:50–55

    Article  PubMed Central  PubMed  Google Scholar 

  32. Willis B, Javalkar V, Vannemreddy P, Caldito G, Matsuyama J, Guthikonda B, et al. (2009) Ventricular reservoirs and ventriculoperitoneal shunts for premature infants with posthemorrhagic hydrocephalus: an institutional experience. J Neurosurg Pediatr 3:94–100

    Article  PubMed  Google Scholar 

Download references

Disclosures

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Financial support

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Edward S. Ahn.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, J.Y., Jackson, E.M., Jallo, G.I. et al. Shunt revision requirements after posthemorrhagic hydrocephalus of prematurity: insight into the time course of shunt dependency. Childs Nerv Syst 31, 2123–2130 (2015). https://doi.org/10.1007/s00381-015-2865-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-015-2865-5

Keywords

Navigation