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Updated: Jun 17, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Peripheral white blood cell patterns in children with hydrocephalus as a response to ventriculo-peritoneal shunt
Bartosz Polis1, Krzysztof Zeman2, Krzysztof Zakrzewski1
1Department of Neurosurgery, Polish Mother's Memorial Hospital- Research Institute in Lodz, Lodz, Poland.
Insights
Shunt infections from S. epidermidis in children with hydrocephalus trigger an early immune response. Cerebrospinal fluid changes, including protein levels, precede white blood cell increases, with monocytes aiding recovery.
Area of Science:
- Neuroscience
- Immunology
- Pediatrics
Background:
- Shunt infection is a common complication in pediatric hydrocephalus treatment.
- Pathogen invasion route influences the central nervous system (CNS) immune response.
- Staphylococcus epidermidis (S. epidermidis) is a frequent cause of shunt infections.
Purpose of the Study:
- To analyze the immune response to S. epidermidis shunt infections in children with hydrocephalus.
- To correlate laboratory findings with immune system activation.
- To understand the role of specific immune cells and cytokines in the CNS response.
Main Methods:
- Analysis of white blood cell (WBC) counts (neutrophils, monocytes, lymphocytes) in peripheral blood.
- Examination of cerebrospinal fluid (CSF) parameters: pleocytosis, protein, and glucose levels.
- Measurement of selected interleukins (IL-6, CXCL8/IL-8, CCL3/MIP-1a) in CSF.
Main Results:
- Significant increase in all WBC lines upon admission in infected patients.
- Elevated protein levels in CSF were the earliest indicator of infection.
- CSF humoral immune response and cytokine levels peaked post-pathogen clearance, with monocytes playing a key role in normalization.
Conclusions:
- S. epidermidis shunt infection elicits an early peripheral immune response.
- In CNS infections, CSF immune markers like protein elevation can precede pleocytosis.
- Monocytes are crucial for resolving inflammation and normalizing CSF parameters post-infection.
Abstract:
Shunt infection is one of the most common complications of conventional hydrocephalus treatment. The route of invasion of a pathogen can modify the immune response of the CNS. The aim of the study is to analyze the immune response to shunt infection caused by S. epidermidis in children with hydrocephalus. The immune response to the pathogen will be analyzed on the basis of, inter alia, simple laboratory test results, such as changes in the pattern of white blood cells, including neutrophils, monocytes, and lymphocytes. The entire study analyzes changes in general parameters of the cerebrospinal fluid (pleocytosis, protein level, glucose level) and in levels of selected interleukins (IL-6, CXCL8 / IL-8, CCL3 / MIP-1a) in the cerebrospinal fluid. The clinical material analyzed in the study was collected in 2010-2014. The study group consisted of 30 patients, who were admitted to the hospital due to their first-ever episode of valve dysfunction caused by S. epidermidis infection. The control group consisted of 30 children who also suffered from congenital hydrocephalus but had not been operated on before. The most pronounced response to CSF infection in the study group was a significant increase in the counts of all investigated WBC lines in the samples collected immediately after the patients' admission to the ward. The earliest aberration of the CSF was a significant increase in protein level. An infection of a ventriculoperitoneal shunt caused by S. epidermidis evokes a very early peripheral blood response. In children affected by a ventriculoperitoneal valve infection, the humoral immune response detected in the cerebrospinal fluid precedes the increase in the level of pleocytosis. The highest level of cytokines in the cerebrospinal fluid is achieved when the pathogens are cleared. Phagocytes, and, in particular, monocytes, play an important role in the normalization of the cerebrospinal fluid parameters after the elimination of S. epidermidis. The local immune response of the central nervous system plays an important role in extinguishment of the inflammatory process.
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