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      A Retrospective Analysis of Ventriculoperitoneal Shunt Revision Cases of a Single Institute

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          Abstract

          Objective

          Ventriculoperitoneal (VP) shunt complication is a major obstacle in the management of hydrocephalus. To study the differences of VP shunt complications between children and adults, we analyzed shunt revision surgery performed at our hospital during the past 10 years.

          Methods

          Patients who had undergone shunt revision surgery from January 2001 to December 2010 were evaluated retrospectively by chart review about age distribution, etiology of hydrocephalus, and causes of revision. Patients were grouped into below and above 20 years old.

          Results

          Among 528 cases of VP shunt surgery performed in our hospital over 10 years, 146 (27.7%) were revision surgery. Infection and obstruction were the most common causes of revision. Fifty-one patients were operated on within 1 month after original VP shunt surgery. Thirty-six of 46 infection cases were operated before 6 months after the initial VP shunt. Incidence of shunt catheter fracture was higher in younger patients compared to older. Two of 8 fractured catheters in the younger group were due to calcification and degradation of shunt catheters with fibrous adhesion to surrounding tissue.

          Conclusion

          The complications of VP shunts were different between children and adults. The incidence of shunt catheter fracture was higher in younger patients. Degradation of shunt catheter associated with surrounding tissue calcification could be one of the reasons of the difference in facture rates.

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          Most cited references36

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          Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus.

          G Kesava Reddy, Papireddy Bollam, Gloria Caldito (2014)
          Ventriculoperitoneal (VP) shunt surgery is the predominant mode of therapy for patients with hydrocephalus. However, it has potential complications that may require multiple surgical procedures during a patient's lifetime. The objective of this study is to review our long-term experience and evaluate the risk factors for VP shunt failure after initial shunt surgery and after subsequent revisions.
          Article 0 comments Cited 77 times – based on 0 reviews     Review now
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            Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths.

            Kinshuk Raj Srivastava, D. Simon, Donna L. Bratton … (2008)
            The aims of this study were to measure inpatient health care for pediatric hydrocephalus in the US; describe patient, hospital, and hospitalization characteristics for pediatric hydrocephalus inpatient care; and determine characteristics associated with death. A cross-sectional study was performed using the 1997, 2000, and 2003 Healthcare Cost and Utilization Project Kids' Inpatient Databases (KID), nationally representative weighted data sets of hospital discharges for pediatric patients. A hydrocephalus-related hospitalization was classified as either cerebrospinal fluid (CSF) shunt-related (including initial placements, infections, malfunctions, or other) or non-CSF shunt-related. Patients>18 years of age were excluded. The KID provided weighted estimates of 6.657, 6.597, and 6.732 million total discharges in the 3 study years. Each year there were 38,200-39,900 admissions, 391,000-433,000 hospital days, and total hospital charges of $1.4-2.0 billion for pediatric hydrocephalus. Hydrocephalus accounted for 0.6% of all pediatric hospital admissions in the US in 2003, but for 1.8% of all pediatric hospital days and 3.1% of all pediatric hospital charges. Over the study years, children admitted with hydrocephalus were older, had an increase in comorbidities, and were admitted more frequently to teaching hospitals. Compared with children who survived, those who died were more likely to be <3 months of age and have a birth-related admission, have no insurance, have comorbidities, be transferred, and have a non-CSF shunt-related admission. Children with hydrocephalus have a chronic illness and use a disproportionate share of hospital days and healthcare dollars in the US. Since 1997 they have increased in age and in number of comorbid conditions. For important changes in morbidity and mortality rates to be made, focused research efforts and funding are necessary.
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              Shunt implantation: reducing the incidence of shunt infection.

              M Choux, Alexander D. Lang, G Lena … (1992)
              Shunt infection remains the foremost problem of shunt implantation after mechanical malfunctions. Diversionary cerebrospinal fluid shunt implantation has a high complication rate, with 5% to 15% of such shunts becoming infected. Of these infections, 70% are diagnosed within 1 month after surgery and more than 90% within 6 months. Shunt infection in the vast majority of cases is therefore a complication of shunt surgery. The authors review their experience with shunt implantation during two time periods. From January, 1978, to December, 1982, 302 children with hydrocephalus underwent 606 operations. Among these children, 47 (15.56%) developed a proven shunt infection, with an incidence of infection per procedure of 7.75%. As a result of this study, a new protocol for shunt procedures involving modifications in the immediate pre-, intra-, and postoperative management of children undergoing shunt implantation was initiated. With this new protocol, 600 children underwent a total of 1197 procedures between January, 1983, and December, 1990. The incidence of shunt infection decreased dramatically, with two infections (0.33%) in 600 patients and a per-procedure rate of 0.17%. The overall annual risk of a shunt infection in the pediatric neurosurgical unit is currently 1.04%.
              Article 0 comments Cited 54 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Korean Neurosurg Soc
                Journal ID (iso-abbrev): J Korean Neurosurg Soc
                Journal ID (publisher-id): JKNS
                Title: Journal of Korean Neurosurgical Society
                Publisher: The Korean Neurosurgical Society
                ISSN (Print): 2005-3711
                ISSN (Electronic): 1598-7876
                Publication date (Print): May 2015
                Publication date (Electronic): 31 May 2015
                Volume: 57
                Issue: 5
                Pages: 359-363
                Affiliations
                Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea.
                Author notes
                Address for reprints: Sung Kyoo Hwang, M.D., Ph.D. Department of Neurosurgery Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 700-721, Korea. Tel: +82-53-200-5654, Fax: +82-53-423-0504, shwang@ 123456knu.ac.kr
                Article
                DOI: 10.3340/jkns.2015.57.5.359
                PMC ID: 4479717
                PubMed ID: 26113963
                SO-VID: 43b07450-cd63-4be1-bb68-dce5a61b4809
                Copyright © Copyright © 2015 The Korean Neurosurgical Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 07 October 2014
                Date revision received : 16 January 2015
                Date accepted : 27 February 2015
                Categories
                Subject: Clinical Article

                ScienceOpen disciplines: Surgery
                Keywords: hydrocephalus,ventriculoperitoneal shunt,complication,shunt fracture,calcification
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: hydrocephalus, ventriculoperitoneal shunt, complication, shunt fracture, calcification

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