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Prospects of CSF shunt independence among chronically shunted patients

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Abstract

Background and objectives

CSF shunt placement for hydrocephalus and other etiologies has arguably been the most life-saving intervention in pediatric neurosurgery in the past 6 decades. Yet, chronic shunting remains a source of morbidity for patients of all ages. Neuroendoscopic surgery has made shunt independence possible for newly diagnosed hydrocephalic patients. In this study, we examine the prospects of shunt independence with or without endoscopic third ventriculostomy (ETV) in chronically shunted patients.

Methods

After IRB approval, a retrospective analysis was completed on patients whose shunt was ligated or removed to achieve shunt independence, with or without ETV. Clinical and imaging data were collected.

Results

Eighty-eight patients with CSF shunts had their shunt either ligated or removed, 57 of whom had a concomitant ETV. Original reasons for shunting included: congenital hydrocephalus 20 (23%), post-hemorrhagic hydrocephalus (PHH) of prematurity 14 (16%), aqueductal stenosis 10 (11%), intracranial cyst 8 (9%), tumor 8 (9%), infantile subdural hematomas 8 (9%), myelomeningocele 7 (8%), post-traumatic hydrocephalus 7 (8%) and post-infectious hydrocephalus 6 (7%). The decision to perform a simultaneous ETV was made based on etiology. Forty-nine (56%) patients became shunt independent. The success rate was 46% in the ETV group and 73% in the no ETV group. Using multivariate analysis and Cox Proportional Hazards models, age > 4 months at shunt placement (p = 0.032), no shunt revisions (p = 0.01), select etiologies (p = 0.043), and ETVSS > 70 (in the ETV group) (p = 0.017), were protective factors for shunt independence.

Conclusion

Considering the long-term complications of shunting, achieving shunt independence may provide hope for improved quality of life. While this study is underpowered, it provides pilot data identifying factors that predict shunt independence in chronically shunted patients, namely age, absence of prior shunt revision, etiology, and in the ETV group, the ETVSS.

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Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

Not applicable.

Funding

Theodore W. Batterman Family Foundation.

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Authors and Affiliations

  1. Departments of Neurological Surgery, University of Wisconsin, Madison, WI, USA

    Joyce Koueik & Bermans J. Iskandar

  2. Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA

    Aimee Teo Broman

  3. University of Wisconsin School of Medicine and Public Health, K4/832 Clinical Science Center, Mail Code, 600 Highland Avenue, Madison, WI, 8660, 53792-8660, USA

    Bermans J. Iskandar

Authors
  1. Joyce Koueik
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  2. Aimee Teo Broman
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  3. Bermans J. Iskandar
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Contributions

J.K.: data acquisition and analysis, and first draft manuscript development; A.B.: statistical analysis and data interpretation; J.K. and B.I.: concept development, data interpretation, and manuscript development and editing.

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Correspondence to Bermans J. Iskandar.

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The authors declare no competing interests.

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Koueik, J., Broman, A.T. & Iskandar, B.J. Prospects of CSF shunt independence among chronically shunted patients. Childs Nerv Syst (2024). https://doi.org/10.1007/s00381-024-06399-4

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