Rate and risk factors of shunt revision in pediatric hydrocephalus patients - population-based study.

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Rate and risk factors of shunt revision in pediatric hydrocephalus patients - population-based study.

World Neurosurg. 2017 Feb 14;:

Authors: Tervonen J, Leinonen V, Jääskeläinen JE, Koponen S, Huttunen TJ

Abstract
BACKGROUND: Ventriculoperitoneal shunt (VPS) is a common treatment for patients with hydrocephalus (HC). However, it carries a risk for complications which may require further revisions. We studied the surgical outcome of pediatric hydrocephalus patients in a population-based setting.
METHODS: A total of 80 patients of age ≤16 years old who required VPS due to HC were included, and their medical charts and imaging findings were studied.
RESULTS: The mean age at the time of initial shunt placement was 3.2 years (SD 4.5) and the mean follow-up time was 3.3 (SD 2.9) years and 57% were males. Half of the patients underwent shunt revision with the mean time to first revision of 8 months. Patients ≤6 months had higher shunt revision rate when compared to the older ones (p<0.001). The most common causes for HC requiring VPS were tumors (27.5%), congenital defects (CD) (22.5%), and intraventricular hemorrhage (IVH) (19%). In IVH and CD patient group revision rates were 67 % (p=0.017) and 72% (p=0.016), respectively, as compared to tumor group (32%). Programmable valves (56%) were more common than non-programmable valves but there was no significant difference in shunt survival (p=0.632). The mean biparietal measure change between pre- and postoperative images was in non-revised group +0.9mm and +6.6mm in revision group (p=0.003).
CONCLUSIONS: Half of the shunted pediatric HC patients required revision. Age ≤6months, IVH, CD etiologies for HC were associated with increased the risk of shunt revision. Most of the revisions were done during the first year after the initial shunting.

PMID: 28213196 [PubMed - as supplied by publisher]

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