Death in Shunted Hydrocephalic Children in the 1990s

Iskandar, Bermans J.; Tubbs, Shane; Mapstone, Timothy B.; Grabb, Paul A.; Aa, Bartolucci; Oakes, W. Jerry

doi:10.1159/000028644

Cited by 85 publications

(43 citation statements)

References 15 publications

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“…This is well within the published range in the current literature [9, 10, 11, 12, 22, 26, 29]. We observed a 1.4% mortality rate over the study period, while recent reports suggest a mortality rate of up to 4% may be observed within 36 months in patients with shunted hydrocephalus [30]. Piatt and Carlson [11]report a median shunt survival time of 6 years, whereas 50% of shunts inserted by Liptak and McDonald [10]had failed by 23 months.…”

Section: Discussionsupporting

confidence: 91%

Cerebrospinal Fluid Shunt Survival and Etiology of Failures: A Seven-Year Institutional Experience

et al. 2002

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Background: Innovations in shunt technology and neuroendoscopy have been increasingly applied to shunt management. However, the relative life span of shunts and the etiology of shunt failure have not been characterized recently. Methods: We reviewed the records of all shunting procedures at our institution between January 1992 and December 1998. Independent predictors of shunt failure were analyzed via multivariate Cox regression analysis in 836 shunting procedures. Independent predictors of the etiology of failure (infection, proximal obstruction, distal malfunction) were analyzed via multivariate logistic regression analysis in the 383 shunts which failed. Results: A total of 353 pediatric patients underwent 308 shunt placements and 528 revisions. The risk (hazard ratio; HR) of shunt failure decreased as a function of time in both primary placements and revised shunts. In failed shunts, the odds of infection decreased 4-fold per year of shunt function, while the odds of distal malfunction increased 1.45-fold per year. Increasing number of shunt revisions (HR 1.31, p < 0.05), decreasing patient age in years (HR 1.04, p < 0.001), gestational age <40 weeks (HR 2.15, p < 0.001) but not the etiology of hydrocephalus were associated with an increased risk of shunt failure. Revisions versus primary placements, Dandy-Walker cysts and gestational age <40 weeks were independently associated with proximal, distal and infectious causes of failure, respectively. Conclusions: The long-term shunt revision rates observed here are similar to those reported over the past 2 decades. Shunt life span remains poorer in shunt revisions and in younger patients. Patient characteristics may suggest a specific risk and mechanism of failure, aiding in the long-term management of shunted hydrocephalus.

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Section: Discussionsupporting

confidence: 91%

Cerebrospinal Fluid Shunt Survival and Etiology of Failures: A Seven-Year Institutional Experience

et al. 2002

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“…It is accompanied in 80–90% of cases by shunt-dependent hydrocephalus, which accounts for a substantial portion of the long-term morbidity and mortality associated with the disease [1]. Most children with hydrocephalus will require multiple shunt revisions, and shunt dependence carries with it a 1% per year mortality [2]. While improvements in vitamin supplementation and prenatal education and screening are significantly reducing the incidence of myelomeningocele, new cases continue to occur at the rate of 1 per 1,000 live births in high-risk regions of the US [3].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Intrauterine Myelomeningocele Repair on the Incidence of Shunt-Dependent Hydrocephalus

Tulipan¹,

Sutton²,

Bruner

et al. 2002

Pediatr Neurosurg

171

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Background: Intrauterine myelomeningocele repair (IUMR) was first successfully performed in 1997. Preliminary reports suggest that this procedure reduces the incidence of shunt-dependent hydrocephalus when compared to conventional postnatal therapy. However, the existing cohort of IUMR patients has not yet been systematically compared to a comparable group of conventionally treated controls. Methods: Patients 1 year old or greater who had undergone IUMR at either Vanderbilt University or the Children’s Hospital of Philadelphia (CHOP) were compared to a group of conventionally treated historical controls treated and followed at CHOP. In order to measure any differences between the groups, patients were stratified according to the level of the myelomeningocele lesion and the gestational age at the time of IUMR. Results: One hundred and four IUMR patients were compared to 189 conventionally treated controls. IUMR resulted in statistically significant reductions in the incidence of shunt-dependent hydrocephalus at both lumbar and sacral lesion levels. When lumbar lesion levels were further stratified, from L1 to L5, it appeared that the benefit of IUMR was statistically significant only at levels below L2. Other factors with a significant impact on hydrocephalus were estimated gestational age and ventricular size at the time of surgery. In particular, statistically significant differences compared to controls were seen in the younger (≤25 weeks) group but not in the older (>25 weeks) group. Conclusions: IUMR appears to substantially reduce the incidence of shunt-dependent hydrocephalus when compared to conventional treatment even when lesion level is taken into account. Patients with lesions above L3 may not share in this benefit. IUMR cannot be justified in fetuses older than 25 weeks of gestation. Additional improvements might be obtained by further reducing the average age at which fetuses are operated upon. It remains to be determined whether this benefit outweighs the potential risks of intrauterine surgery.

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“…Caregiver education about hydrocephalus is considered essential in preventing significant morbidity and even mortality due to shunt failure. 1,17 The Internet is an evolving tool in caregiver/patient education. 2,8,9,14,19,25,26,31 In a bold statement in 1996, Pareras and Martin-Rodriguez 33 stated that "the Internet is dividing medical professionals, creating two kinds of people: those who take advantage of the benefits which the information era offers, and those who live in ignorance of these benefits."…”

mentioning

confidence: 99%

Technology preferences among caregivers of children with hydrocephalus

Naftel¹,

Safiano²,

Falola³

et al. 2013

PED

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Object The Internet and social media are powerful disseminators of medical information, providing new portals for patient care. The authors of this study evaluated current technology hardware, Internet, and social media use and their socioeconomic relationships among caregivers of children with hydrocephalus. Methods A written survey was completed in the neurosurgical clinics at the University of Alabama at Birmingham by 300 parents of children with shunted hydrocephalus between October 26, 2010, and July 26, 2011. Results Computer use (94.6%), Internet use (91.7%), smartphone use (56.9%), and Internet research on hydrocephalus (81.9%) were prevalent. However, for each of these four utilizations there was significantly lower access by caregivers of minority races (p = 0.04, 0.03, 0.002, and < 0.0001, respectively), lower income (p = 0.02, 0.01, < 0.0001, and < 0.0001, respectively), and lower level of education (p = 0.001, 0.002, < 0.0001, and 0.001, respectively). Personal use of social media was prevalent (95.1% of all Internet users) with use being more prevalent among less-educated than higher-educated caregivers (p = 0.017). Hydrocephalus-related social media use (59.5% of Internet users) was not associated with socioeconomic factors. For hydrocephalus education on the Internet, caregivers chose information websites such as Wikipedia or the Hydrocephalus Association as preferred platforms; these preferences were followed by use of social media websites. Facebook and YouTube were the preferred social media platforms for personal and hydrocephalus-related use. Parents indicate moderate skepticism about the trustworthiness of the Internet; only 21.7% always trust the online sources. Most parents (89.8%) say that they would visit neurosurgeon-recommended websites. Of Internet-using caregivers, 28.6% use the Internet or social media to find hydrocephalus support groups, and 34.8% have used the Internet to communicate with other caregivers who have children with similar conditions. Conclusions Technology hardware, the Internet, and social media are widely used with some skepticism by parents of children with shunted hydrocephalus. Caregivers are interested in physician-recommended Internet resources. Socioeconomic factors including race, income, and level of education reveal a disparity in access to some of these resources, although all groups have relatively high use. Unlike typical technology use, social media use is breaking down the digital divide among ethnic and socioeconomic groups.

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Death in Shunted Hydrocephalic Children in the 1990s

Cited by 85 publications

References 15 publications

Cerebrospinal Fluid Shunt Survival and Etiology of Failures: A Seven-Year Institutional Experience

Cerebrospinal Fluid Shunt Survival and Etiology of Failures: A Seven-Year Institutional Experience

The Effect of Intrauterine Myelomeningocele Repair on the Incidence of Shunt-Dependent Hydrocephalus

Technology preferences among caregivers of children with hydrocephalus

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