Related Experiment Videos
Ventricular shunt survival in children with neural tube defects
Insights
Pediatric hydrocephalus shunt malfunctions are common, with 50% failing by 4.5 years. Shunts inserted in the first year of life showed higher failure rates, impacting children with neural tube defects.
Area of Science:
- Pediatric Neurosurgery
- Medical Device Reliability
- Congenital Malformations
Background:
- Ventricular shunting significantly improves outcomes for pediatric hydrocephalus.
- Shunt malfunctions are a frequent complication, leading to substantial patient morbidity.
- Children with neural tube defects and hydrocephalus are particularly susceptible to shunt issues.
Purpose of the Study:
- To document the incidence and patterns of shunt malfunctions in children with neural tube defects and hydrocephalus.
- To identify factors influencing shunt survival in this pediatric population.
- To assess the clinical and economic impact of shunt failures.
Main Methods:
- Life-table analysis was employed to study shunt survival in 67 children with neural tube defects and hydrocephalus, born since 1973.
- Data collected included shunt failure rates, timing of insertion, neurological function, and specific device characteristics.
- Statistical analysis was performed to identify correlations between various factors and shunt failure.
Main Results:
- A substantial proportion of shunts failed within the first year (37%), with 50% failing by 4.5 years post-insertion.
- Shunt failure rates were similar regardless of previous shunt history, shunt brand, pressure rating, neurological status, or timing of neural tube defect closure relative to shunt insertion.
- Shunts inserted within the first year of life demonstrated a significantly higher failure rate compared to those inserted later (p < 0.05).
- Ventricular catheter replacement was required in 68% of shunt revisions.
- Shunt failures contributed approximately 1% of pediatric admissions, with significant associated costs and length of stay.
Conclusions:
- Shunt malfunctions remain a common and serious complication in children with hydrocephalus, particularly those with neural tube defects.
- Early-life shunt insertion (within the first year) is a significant risk factor for shunt failure.
- Despite improvements in care, shunt reliability continues to be a critical challenge in managing pediatric hydrocephalus.
Abstract:
Ventricular shunting has dramatically improved the care of children with hydrocephalus. Yet shunt malfunctions are extremely common and cause significant morbidity. To document shunt problems in children with a neural tube defect and hydrocephalus, 67 children born since 1973 were studied via life-table analysis. 28% of the shunts failed within the first 6 months after insertion, 37% failed within the first year and 50% failed by 4 1/2 years after insertion. Shunt survival was similar in children whether or not they had previous shunt failures. The brand of shunt system and pressure rating, the level of neurological function, the interval between closure of the neural tube lesion and shunt insertion, and head circumference percentile at the time of insertion were also not correlated with shunt failure. However, shunts inserted in the first year of life were much more likely to fail than those inserted after one year of age (p less than 0.05). 68% of the revisions required replacement of the ventricular catheter. Shunt failure from all causes of hydrocephalus accounted for approximately 1% of paediatric admissions to Strong Memorial Hospital in 1982 with a mean cost of $4,543 and a mean length of stay of 9 days. Thus shunt problems remain both common and serious.