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Published on: October 2, 2014
Postoperative shunt failure following hemispherectomy in pediatric patients with pre-existing hydrocephalus
Nikita Das1, Akshay Sharma2,3, Michael Mann1
1School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Insights
Hydrocephalus risk after hemispherectomy is high. Prior shunt revisions in pediatric epilepsy patients may predict future shunt failure, guiding neurosurgical counseling for those with existing shunts.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Epileptology
Background:
- Hydrocephalus is a significant risk following hemispherectomy for drug-resistant epilepsy (DRE).
- Managing pre-existing shunts in these patients presents postoperative challenges.
- A clear strategy for maintaining shunt patency is lacking.
Purpose of the Study:
- To examine the incidence of shunt failure in pediatric hemispherectomy patients with pre-existing ventricular shunts.
- To identify predictors of shunt failure in this specific patient population.
Main Methods:
- Retrospective chart review of pediatric DRE patients who had ventricular shunts before hemispherectomy.
- Data collection included shunt history, hydrocephalus etiology, epilepsy duration, and surgical details.
- Univariate analysis using Fisher's exact test and Pearson correlation with Bonferroni correction.
Main Results:
- 26.3% of patients (5/19) with pre-existing shunts experienced postoperative shunt malfunction.
- All patients with shunt malfunction had undergone at least one shunt revision prior to hemispherectomy.
- A significant association was found between pre- and post-hemispherectomy shunt revisions.
Conclusions:
- Earlier shunt revision surgery may indicate a higher likelihood of subsequent shunt revision after hemispherectomy.
- Findings can assist neurosurgeons in counseling pediatric patients with pre-existing shunts undergoing hemispherectomy.
Objective:
The risk of hydrocephalus following hemispherectomy for drug resistant epilepsy (DRE) remains high. Patients with pre-existing hydrocephalus pose a postoperative challenge, as maintaining existing shunt patency is necessary but lacks a clearly defined strategy. This study examines the incidence and predictors of shunt failure in pediatric hemispherectomy patients with pre-existing ventricular shunts.
Methods:
We performed a retrospective chart review at our center to identify pediatric patients diagnosed with DRE who were treated with ventricular shunt prior to their first hemispherectomy surgery. Demographic and perioperative data were obtained including shunt history, hydrocephalus etiology, epilepsy duration, surgical technique, and postoperative outcomes. Univariate analysis was performed using Fisher's exact test and Pearson correlation, with Bonferroni correction to a = 0.00625 and a = 0.01, respectively.
Results:
Five of nineteen (26.3%) patients identified with ventriculoperitoneal shunting prior to hemispherectomy experienced postoperative shunt malfunction. All 5 of these patients underwent at least 1 shunt revision prior to hemispherectomy, with a significant association between pre- and post-hemispherectomy shunt revisions. There was no significant association between post-hemispherectomy shunt failure and valve type, intraoperative shunt alteration, postoperative external ventricular drain placement, hemispherectomy revision, lateralization of shunt relative to resection, postoperative complications, or postoperative aseptic meningitis. There was no significant correlation between number of post-hemispherectomy shunt revisions and age at shunt placement, age at hemispherectomy, epilepsy duration, or shunt duration prior to hemispherectomy.
Conclusions:
Earlier shunt revision surgery may portend a subsequent need for shunt revision following hemispherectomy. These findings may guide neurosurgeons in counseling patients with pre-existing ventricular shunts prior to hemispherectomy surgery.
