Pediatric shunt revision analysis within the first year of shunt placement: A single center experience

Abstract

Background: Hydrocephalus is a common problem in neurosurgery with shunt placement remains the mainstay of the management. However, shunt placement generally requires following surgical procedures, including shunt revision. Despite the recent developments, the incidence of shunt failure remains high, approximately 30–51% in the 1st year following the shunt placement. Methods: An observational retrospective study of pediatric neurosurgery patients whom underwent CSF shunting procedure, both primary and repeated VPS, VAS, CPS, and subdural-peritoneal shunt procedures between January 2018 and May 2019. The patients were observed for 12 months for potential complication requiring shunt revision following the shunt placement. Results: A total of 142 patients underwent shunt placement. The shunt revision within 12 months was found in 26 patients (18.3%), 25 cases were VPS (96.2%) and one case was CPS (3.8%). The mean period of time between shunt placement to shunt revision was 3.96 months. Age of under 6 months old during the shunt placement showed significantly higher risk for shunt revision (RR 2.32 CI 1.13–4.74, P = 0.018). The most common diagnosis requiring shunt revision was congenital anomaly (16 cases, 61.5%). The most common cause of revision was shunt malfunction, with 21 cases (80.8%) followed by infected shunt with 5 cases (19.2%). Conclusion: The 1st year observation showed relatively high rate for shunt revision. The patient underwent shunt procedure should be regularly followed up in long period for better evaluation of the outcome. The application of shunt registry in some countries appears to be efficient and beneficial for sustainable follow-up in patients underwent shunt placement.

Acute traumatic subdural effusion with hemorrhage in children under 3 years of age： a study of clinical characteristics and treatment strategy

“…A variety of treatment modalities are used in the surgical management of ATSEH in children, including subcutaneous reservoir placement, craniotomy, percutaneous subdural puncture with or without drain placement, drilled craniotomy with or without drain placement and subdural-peritoneal shunt (SPS) [29,30]. In this study, we used burr-hole craniotomy with drain to treat TSHE, which was mainly based on our understanding that the essence of ATSEH is acute hydrocephalus and thus resulting in increased intracranial pressure.…”

Clinical Chronicle: The Use of Ventriculo-Atrial Shunt in Tuberculous Hydrocephalus Treatment

“…This is an emergency situation that could result in fatalities. Nonetheless, if it founded fast, will still be manageable, and the risk of shunt-related problems has been lowered as a result of recent breakthroughs in surgical technique and shunt design [6].…”

“…Some literature said that shunt infection usually happens in the first six months after the procedure, with the highest rate in the first 2 months ranging from 5%-11%. Based on research by Azzam, et al (2021), they concluded that 88.7% of total VPshunt procedures (126 cases), and 5.6% of total VA-shunt procedures (8 cases), the revision rate is 96.2% (25 cases) in VP-shunt cases [6].…”