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Childs Nerv Syst. 2016 Aug;32(8):1405-14. doi: 10.1007/s00381-016-3090-6. Epub 2016 Jun 9.

Outcome of ventriculoperitoneal shunt and predictors of shunt revision in infants with posthemorrhagic hydrocephalus.

Author information

1
Department of Neurosurgery, LSU Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130-3932, USA.
2
Department of Neurosurgery, LSU Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130-3932, USA. ananda@lsuhsc.edu.

Abstract

OBJECT:

Ventriculoperitoneal (VP) shunts in infants with posthemorrhagic hydrocephalus (PHH) are prone to failures, with some patients at risk for multiple revisions. The objective of our study is to observe long-term outcomes and identify factors leading to proximal and distal multiple failures.

METHODS:

We performed a retrospective review of infants with PHH that required VP shunt placement between 1982 and 2014. These patients were monitored clinically and radiographically after VP shunt placement.

RESULTS:

A total of 502 surgical procedures (initial shunt insertion and revisions) were performed, with 380 shunt revisions in 102 (84 %) patients. Median shunt survival time was 54 months (0.03-220 months). Shunt survival was significantly affected by the following factors: intraventricular hemorrhage (IVH, grade II-III, 95 months vs. grade IV, 28 months, p = 0.022), birth weight (<1.5 kg, 59 months vs. >1.5 kg, 22 months, p = 0.005), gestational age (>27 weeks, 90 months vs. <27 weeks, 20 months, p < 0.0001), distal vs. proximal revision (133 months vs. 48 months, p = 0.013), obstruction (yes, 78 months vs. no, 28 months, p = 0.007), and infection (no, 75 months vs. yes, 39 months, p = 0.045). Regression analysis revealed that multiple gestation, head circumference (>27 cm), congenital anomalies, infection, and obstruction increased the proximal and distal shunt malfunction.

CONCLUSION:

Long-term outcome of VP shunt placement in infants revealed a relatively high rate of complications requiring shunt revision as late as 30 years after initial placement. Infants with VP shunts should be monitored lifelong of these patients by neurosurgeons.

KEYWORDS:

Hydrocephalus; Intraventricular hemorrhage; Revision; Shunt

PMID:
27278283
DOI:
10.1007/s00381-016-3090-6
[Indexed for MEDLINE]

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