Removal of subdural-peritoneal shunts in infants

A common method of treating subdural collections is the insertion of a unilateral subdural-peritoneal shunt. In most cases, the shunt can be removed a few months later, but there is the anxiety that removal could cause complications and some surgeons elect to leave the shunts permanently implanted, on the understanding that they are not causing problems. A retrospective review was performed of patients who had their subdural shunts removed after CT evidence of resolution of the collections, with the intention of assessing the possible risks and benefits.

Of the 19 patients who had insertion of a subdural shunt for infantile subdural collections by a single surgeon between 1999 and 2003, 14 were eligible for removal of the shunt and 13 had the shunt removed, while in 1 patient the parents refused the option of removal. Mean age at shunt insertion was 9.1 months (range 1.5-25.4 months). The mean shunt implantation time was 5 months (range 0.5-11 months). The mean follow-up period was 30.3 months (range 1-59 months).

All shunts were removed successfully without complications. There was difficulty in removing the shunt in one case (implantation time 10 months) because of migration of the shunt, requiring extension of the incision and a small craniectomy. None of the patients required re-insertion of the shunt.

Subdural shunts can be removed safely, but it is advisable to perform such an operation during the first 6 months after insertion to avoid undue operative difficulties.