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Rate and risk factors for shunt revision in pediatric patients with hydrocephalus during a 17-year study period: a
Juho Välimaa1, Terhi J Huuskonen2, Joona Tervonen2
1Neurosurgery KUH NeuroCenter, Faculty of Health Science, School of Medicine, Institute of Clinical Medicine, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland. juhoval@student.uef.fi.
Insights
Over half of pediatric hydrocephalus patients need shunt revision surgery, especially those with congenital defects or under six months old. The Strata adjustable valve showed no significant impact on revision rates.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Medical Devices
Background:
- Hydrocephalus (HC) is a condition requiring cerebrospinal fluid (CSF) diversion.
- Ventriculoperitoneal shunt (VPS) surgery is a common treatment for pediatric HC.
- Understanding shunt revision rates and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate surgical outcomes of pediatric hydrocephalus patients undergoing primary VPS.
- To identify risk factors associated with shunt revision in this population.
- To assess the impact of the Strata adjustable valve on revision rates.
Main Methods:
- Retrospective population-based study of 92 pediatric HC patients under 16 years requiring primary VPS.
- Analysis of medical records to determine shunt revision rates and associated risk factors.
- Specific cohort analysis for patients with Strata adjustable valve.
Main Results:
- 54.3% of all shunted patients required at least one revision surgery, most within the first year.
- Congenital defects (70% revision rate) and age under 6 months were linked to higher revision rates.
- The Strata adjustable valve did not significantly alter shunt revision rates compared to other VPS.
Conclusions:
- Pediatric hydrocephalus patients have a high rate of VPS revision, particularly within the first year post-surgery.
- Congenital defects and early infancy are significant risk factors for shunt revision.
- The Strata adjustable valve's efficacy in reducing revisions requires further investigation.
Purpose:
We studied the surgical outcomes of pediatric hydrocephalus (HC) patients requiring primary cerebrospinal fluid (CSF) diversion surgery with ventriculoperitoneal shunt (VPS) in a retrospective population-based study.
Methods:
The medical records of 92 patients under 16 years of age with HC requiring primary VPS were reviewed. Patients with Strata adjustable valve were studied in their own cohort. The rate and the risk factors for shunt revision were analyzed.
Results:
We found 92 patients treated with primary VPS. Strata adjustable valve shunt was used in 43 patients. The mean age at the time of primary shunt insertion was 3.2 years (SD 4.7 years). The mean follow-up time for shunted patients was 5.9 years (SD 6.8 years), and 5.3 years (SD 5.3 years) for the Strata valve subgroup. The most common etiologies of HC were tumors (29.3%), congenital defects (CD) (21.7%), and intraventricular hemorrhage (IVH) (22.8%) in shunted patients. During the follow-up period, 54.3% of all shunted patients and 48.8% of Strata valve shunted patients underwent at least one revision surgery. The mean time to revision surgery was 1.0 years. Revision rates in the CD group (70%) were higher compared to the tumor group (37%) (P = 0.044). Patients younger than 6 months had higher shunt revision rates than older patients (P = 0.036).
Conclusions:
Out of the 92 shunted patients, 54.3% underwent revision surgery, with most revisions occurring within the first year after initial VPS placement. Patient characteristics, such as congenital defects and age under 6 months, were associated with a higher risk for shunt revision. The use of the Strata adjustable valve did not have a statistically significant impact on shunt revision rates.
