Experience in shunt management on revision free survival in infants with myelomeningocele

  • Sara Al-Hakim
  • Andreas Schaumann
  • Joanna Schneider
  • Matthias Schulz
  • Ulrich-Wilhelm Thomale
Original Paper

Abstract

Objective

Depending on the etiology of hydrocephalus in childhood, the shunt therapy still remains challenging due to frequent shunt complications leading to possible revisions such as shunt infection or shunt malfunction. In myelomeningocele (MMC) patients who often require shunt therapy, higher revisions rates were reported. In a single-center retrospective study, experiences on shunt regimen on hydrocephalus associated with MMC are presented.

Methods

Data of 160 infant hydrocephalus cases younger than 1 year of age at the time of implantation were retrospectively reviewed from the hospital database. These patients received an adjustable differential pressure valve with gravitational unit and antibiotic impregnated catheters as a primary or secondary implant during the time period of April 2007 to July 2015. The subgroup of infants cases with MMC (n = 44; age 50.6 ± 80.6 days) were compared to the remaining cohort of other hydrocephalus etiology (control group). The shunt and valve revision free survival rates were recorded until July 2017.

Results

During the mean follow-up of 48.7 ± 19.2 (7–114) months, the shunt revision free survival was 87% at 1 year and 49% at 60 months in the MMC cohort. The control group showed a shunt survival rate of 68% at 1 year and 39% at 60 months. Similarly, the valve revision free survival rate showed a significant higher rate of 92% at 1 year and 69% at 60 months in the MMC group compared to the control group (75% at 1 year and 51% at 60 months; p < 0.05). During the entire follow-up period, 37% of the MMC infants underwent a revision operation in contrast to the control group of 40%.

Conclusion

The presented shunt strategy showed improved revision free survival rates in infants with a MMC-related hydrocephalus in comparison to other etiologies of hydrocephalus in infants, which might relate to infection prophylaxis and high drainage resistance integrated in the shunt system.

Keywords

Hydrocephalus Spina bifida Ventriculo peritoneal shunt Failure rate Gravitational assistance Shunt infection 

Notes

Compliance with ethical standards

The study was approved by the local ethics committee (approval no. EA2/093/17).

Conflict of interest

UWT and AS received lecture honorarium from Miethke Aesculap Comp. in the past. All other authors have no conflict of interest to declare.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sara Al-Hakim
    • 1
  • Andreas Schaumann
    • 1
  • Joanna Schneider
    • 2
    • 3
  • Matthias Schulz
    • 1
  • Ulrich-Wilhelm Thomale
    • 1
    • 4
  1. 1.Pediatric Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
  2. 2.Department of Pediatric NeurologyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of HealthBerlinGermany
  3. 3.Berlin Institute of HealthBerlinGermany
  4. 4.Campus Virchow KlinikumCharité Universitätsmedizin BerlinBerlinGermany

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