Experience with 1201 Cerebrospinal Fluid Shunt Procedures

Abstract

This report of our experience with 1,201 cerebrospinal fluid shunt procedures over a 17-year period includes two time periods: from 1965 to 1974 and from 1975 to 1982. The overall operative infection rate fell from 10.7% in the former period to 3.6% in the latter period. The overall average number of revisions fell from 1.8 to 0.77. The number of revisions for patients with infected shunts in the latter period was 4.07. Three hundred and eighty-four shunts were studied in the latter period for the effects of prophylactic antibiotics. No significant difference was found between the infection rate of 5.6% in the nonantibiotic group and the infection rate of 2.1% in the group receiving intravenous and intraventricular methicillin and gentamicin. Differences in the operative infection rates for patients with and without meningomyelocele and those operated on by different surgeons were not significant. The only mortalities were from nonoperative and noncerebrospinal fluid shunt causes.

Perioperative risk factors for short term shunt revisions in adult hydrocephalus patients

“…Studies have shown an overall 1 year shunt failure rate of 30–40%5 6 7 8 and shunt failures most commonly occur within 6 months postoperatively 4. Infection occurs in 3–15%4 8 9 10 11 12 13 14 of patients after shunt surgery while an infection rate of 0.3% has been achieved after modifying the operative practice 15. The mortality rate related to shunt surgery varies from 2% to 9% 16 17…”

“…These include prematurity and age of the patient,12 13 14 18 aetiology of the hydrocephalus,14 shunt type,12 19 20 surgeon’s operating experience,8 9 10 12 15 21 number of revisions,14 position of ventricular catheter tip,22 distal placement of the catheter,23 handling of shunt equipment,4 24 shaving of the scalp8 25 and duration of the operation 12…”

Pediatric Idiopathic Intracranial Hypertension: A not so Rare and Benign Condition

“…11 Surgical modalities vary from minimally invasive endoscopic optic nerve sheath fenestration (ONSF) to shunting procedures to medial or lateral orbitotomy and transconjunctival optic nerve sheath decompression to subtemporal craniotomy. [12][13][14][15][16][17] …”

Cerebral vasospasm in shunt infection

“…Early shunt infection rates range from 0.3-15% [1,2], with a mortality rate ranging from 1.5-22% [3,4]. Many factors are associated with shunt infection, including the age of the patient, the etiology of hydrocephalus, and the type of shunt implanted [1][2][3][4][5]. Delayed shunt infections are thought to be independent of the initial shunt surgery.…”