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

Abstract

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...

Intradural spine surgery may not carry an increased risk of shunt revision compared with extradural spine surgery in pediatric patients with myelomeningocele

“…21 Venable et al attempted to quantify the risk of shunt malfunction after elective intradural surgery and found a shunt failure rate of 10.7% within 90 days, with a median of 5 days from intradural surgery to shunt revision. 24 These rates of shunt revision are comparable to those found in our study. Interestingly, in the study by Venable et al, none of the 17 patients with dysraphism-associated hydrocephalus experienced shunt failure after intradural surgery.…”

“…A relationship between entry into the subarachnoid space, derangement in CSF dynamics, and interruption of shunt function seems biologically plausible and has been reported by several groups. 19,23,24 Shunt malfunction produces pain, consumes considerable health care resources, and exposes the child to additional shunt-related risks. In this study, we used a cohort study design to compare rates of shunt malfunction after intradural and extradural spine surgeries among pediatric patients with MMC.…”

Invasive Intracranial Electroencephalogram (EEG) Monitoring for Epilepsy in the Pediatric Patient With a Shunt

“…To the best of our knowledge, no studies have previously quantified the risk of shunt malfunction in the setting of SEEGs. In a retrospective study on the risk of shunt malfunction in pediatric patients with existing shunts who underwent elective intradural operations, 12.8% of patients experienced shunt malfunctions within 90 days of elective intradural surgery with a median time to failure of nine days [ 20 ]. Risk factors associated with shunt malfunction included an intraventricular surgical approach, shorter time since shunt related surgery, and young age.…”