Ventriculoperitoneal Shunt Complications in California

Wu, Yvonne W.; Green, Nella L; Wrensch, Margaret; Zhao, Shoujun; Gupta, Nalin

doi:10.1227/01.neu.0000290903.07943.af

Cited by 289 publications

(222 citation statements)

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“…17 In our study, the overall complication rate was 43%. Patients undergoing both operations at the same time and patients with large cranial defect and severe brain bulging had much higher complication rates (56%, 45%, and 51%, respectively) than previously published complication rates for cranioplasty and shunt placement.…”

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Evaluation of simultaneous cranioplasty and ventriculoperitoneal shunt procedures

Heo

Park²,

Cho³

et al. 2014

JNS

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Decompressive craniectomy is a life-saving procedure used in the treatment of medically refractory intracranial hypertension in patients suffering from traumatic brain injury, cerebral infarction, subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH). 1,8,9,14 Indications for cranioplasty are usually protective and cosmetic. Cranioplasty has also been reported to facilitate neurological recovery 3,15 and improve cerebral blood flow, CSF hydrodynamics, and metabolic activity after a decompressive craniectomy.2-7 Some patients with severe brain swelling treated with decompressive craniectomy may develop communicating hydrocephalus, with or without persistent brain bulging. Consequently, these patients also require a ventriculoperitoneal (VP) shunt to relieve the hydrocephalus.There is no consensus as to the timing of the cranioplasty and VP shunt placement in patients who require both operations. A large cranial defect could lead to turbulence in CSF circulation hydrodynamics and cerebral blood perfusion due to exposure to atmospheric pressure, followed by hydrocephalus. 4-7 Cranioplasty and VP shunts each affect CSF circulation, but exactly how each operation affects it is as yet unknown. Thus, undergoing both operations at the same time may cause complications due to unexpected CSF circulation changes. In this study, we assessed the results of undergoing cranioplasty and VP shunting at the same time in patients with cranial defects and hydrocephalus. We hypothesized that the outcomes after simultaneous cranioplasty and VP shunting may be worse than those when the operations are performed at different times. Object. Some patients with severe brain swelling treated with decompressive craniectomy may develop hydrocephalus. Consequently, these patients require cranioplasty and a ventriculoperitoneal (VP) shunt to relieve the hydrocephalus. However, there is no consensus as to the timing of the cranioplasty and VP shunt placement in patients requiring both. The authors assessed the results of performing cranioplasty and VP shunt placement at the same time in patients with cranial defects and hydrocephalus.Methods. A retrospective review was performed of 51 patients who had undergone cranioplasty and VP shunt operations after decompressive craniectomy for refractory intracranial hypertension between 2003 and 2012 at the authors' institution. Patient characteristics, data on whether the operations were performed simultaneously, brain bulging, hydrocephalus, cranial defect size, and complications were analyzed.Results. The overall complication rate was 43% (22 of 51 patients). In 32 cases, cranioplasty and VP shunt placement were performed at the same time. Complications included subdural hematoma, subdural fluid collection, and infection. The group undergoing cranioplasty and VP shunt placement at the same time had higher complication rates than the group undergoing the procedures at different times (56% vs 21%, respectively). The severity of complications was also greater in the former group. Patients with...

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confidence: 48%

“…Such complications could be caused, or aggravated, by CSF drainage via the VP shunt. 17 The higher complication rate in patients undergoing the two operations at the same time may be explained by difficulties in adjusting the VP shunt pressure in these patients.…”

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Evaluation of simultaneous cranioplasty and ventriculoperitoneal shunt procedures

Heo

Park²,

Cho³

et al. 2014

JNS

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“…21) Catheter migration into or perforation of the intestine, vagina, umbilicus, or scrotum is a rare but potential complication, especially in children. 4) We treated a 5-year-old boy with peritoneal catheter migration into the left scrotum and discuss the characteristics of scrotal catheter migration.…”

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Scrotal Migration of the Peritoneal Catheter of a Ventriculoperitoneal Shunt in a 5-Year-Old Male -Case Report-

Kita

Hayashi

Kinoshita

et al. 2010

Neurol. Med. Chir.(Tokyo)

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A 5-year-old male presented with scrotal migration of the catheter from a ventriculoperitoneal shunt manifesting as left scrotal swelling 4 months after implantation. Surgical obliteration of the patent peritoneal processus vaginalis that forms a corridor from the peritoneum to the scrotum was performed to avoid shunt malfunction. Review of the 26 reported cases including the present case revealed that most patients were up to 18 months old. Our patient was the oldest. Migration tended to occur within 6 months after implantation (mean 3.8 months, median 1.0 month). Involvement of the right side of the scrotum was prevalent (23 of 26 cases). Patent processus vaginalis and small peritoneal cavity probably contribute to scrotal catheter migration.

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“…Much work has been done to elucidate risk factors for shunt failure, such as age, sex, race, socioeconomic status, presence of comorbidities, years with shunt, and the surgeon performing the operation, though the significance of these factors varies considerably between studies. 17,21,24,26,28,29 abbreviations LBCH = Le Bonheur Children's Hospital; VP = ventriculoperitoneal. School of Medicine and Biomedical Sciences, University at Buffalo, New York obJect Surgery for CSF diversion is the most common procedure performed by pediatric neurosurgeons.…”

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What is the risk of a shunt malfunction after elective intradural surgery?

Venable¹,

Green²,

Smalley³

et al. 2015

PED

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A n estimated 36,000 shunt-related operations are performed annually. 5 The well-known early and late complications and malfunctions from shunts result in great burdens for patients, their families, and health care providers. The estimated annual cost of treating pediatric hydrocephalus is 1.4 to 2.0 billion dollars annually. 22 A recent study in a pediatric population showed that 84.5% of patients required at least 1 shunt revision, and 4.7% required 10 or more, resulting in an average of 2.66 revisions at a mean follow-up of 19.9 years.24 Al-Tamimi et al. reported that 12.9% of new shunts fail within 30 days and 28.8% fail within 1 year. Revised shunts fare even worse, with 20.7% failing within 30 days and 40.4% failing within 1 year.2 Though the rates vary from study to study, it is clear that an exceptionally high number of ventricular shunts will require at least 1 revision at some point. Much work has been done to elucidate risk factors for shunt failure, such as age, sex, race, socioeconomic status, presence of comorbidities, years with shunt, and the surgeon performing the operation, though the significance of these factors varies considerably between studies. 17,21,24,26,28,29 abbreviations LBCH = Le Bonheur Children's Hospital; VP = ventriculoperitoneal. School of Medicine and Biomedical Sciences, University at Buffalo, New York obJect Surgery for CSF diversion is the most common procedure performed by pediatric neurosurgeons. The failure rates for shunts remain frustratingly high, resulting in a burden to patients, families, providers, and healthcare systems. The goal of this study was to quantify the risk of a shunt malfunction in patients with an existing shunt who undergo an elective intradural operation. methods All elective intradural surgeries (cranial and spinal) at Le Bonheur Children's Hospital from January 2010 through June 2014 were reviewed to identify those patients who had a functional ventricular shunt at the time of surgery. Patient records were reviewed to collect demographic, surgical, clinical, radiological, and pathologic data, including all details related to any subsequent shunt revision surgery. The primary outcome was all-cause shunt revision (i.e., malfunction or infection) within 90 days of elective intradural surgery. results One hundred and fifty elective intradural surgeries were identified in 109 patients during the study period. There were 14 patients (12.8%, 13 male) who experienced 16 shunt malfunctions (10.7%) within 90 days of elective intradural surgery. These 14 patients underwent 13 craniotomies, 2 endoscopic fenestrations for loculated hydrocephalus, and 1 laminectomy for dorsal rhizotomy. Median time to failure was 9 days, with the shunts in half of our patients failing conclusions This is the first study to quantify the risk of a shunt malfunction after elective intradural surgery. The 90-day all-cause shunt failure rate (per procedure) was 10.7%, with half of the failures occurring within the first 5 postoperative days. Possible risk factors for shunt malfunct...

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Ventriculoperitoneal Shunt Complications in California

Abstract: VP shunt complications are common, especially in children. Further study is needed to explain the associations between demographic factors and elevated shunt complication rates.

Cited by 289 publications

References 19 publications

Evaluation of simultaneous cranioplasty and ventriculoperitoneal shunt procedures

Evaluation of simultaneous cranioplasty and ventriculoperitoneal shunt procedures

Scrotal Migration of the Peritoneal Catheter of a Ventriculoperitoneal Shunt in a 5-Year-Old Male -Case Report-

What is the risk of a shunt malfunction after elective intradural surgery?

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