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Multiloculated hydrocephalus related to cerebrospinal fluid shunt infection
A B Jamjoom1, A A Mohammed, A al-Boukai
1Division of Neurosurgery, King Khalid University Hospital, Riyadh, Saudi Arabia.
Insights
Cerebrospinal fluid (CSF) shunt infection is linked to the development of multiloculated hydrocephalus. Prompt infection clearance is crucial to prevent this complication, especially in post-hemorrhagic cases.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Infectious Diseases
Background:
- Multiloculated hydrocephalus is a complex condition often requiring surgical intervention.
- Shunt infections are a known complication in hydrocephalus management.
- The specific role of shunt infection in the etiology of multiloculated hydrocephalus requires further elucidation.
Purpose of the Study:
- To investigate the association between cerebrospinal fluid (CSF) shunt infection and the development of multiloculated hydrocephalus.
- To identify risk factors and outcomes in patients with shunt infection-associated multiloculated hydrocephalus.
Main Methods:
- Retrospective review of 12 cases of multiloculated hydrocephalus treated between 1988-1994.
- Analysis of patient history, causative organisms, treatment strategies, and outcomes.
- Correlation of shunt infection characteristics with hydrocephalus development.
Main Results:
- Multiloculation developed post-shunt infection in all reviewed cases.
- Gram-negative organisms were the most common cause of infection (8/12 patients).
- Patients with post-hemorrhagic hydrocephalus and persistent infection after 12 days of external drainage were at higher risk.
Conclusions:
- CSF shunt infection plays a significant role in the etiology of multiloculated hydrocephalus.
- Effective management of shunt infections, particularly in post-hemorrhagic hydrocephalus, is critical to prevent multiloculated hydrocephalus.
- Outcomes remain poor for many patients, with high rates of disability and mortality.
Abstract:
This study is an attempt to establish that CSF shunt infection has a role in the aetiology of multiloculated hydrocephalus. The authors carried out a review of 12 cases of multiloculated hydrocephalus who were treated at King Khalid University Hospital between 1988-1994. The multiloculation appears to have developed following the shunt infection in all cases. The hydrocephalus was related to an intraventricular haemorrhage (IVH) in 9 patients and was congenital in 2 patients and post-meningitic in 1 patient. The shunt infection was caused by a gram-negative organism in 8 patients and duration of external ventricular drainage ranged from 9-24 (median 13) days. The diagnosis of multiloculated hydrocephalus was made on average 2 months after the shunt infection. In three patients endoscopic fenestration of intraventricular septations was attempted but was effective in only one case. The other patients were managed by two shunts (9 patients) and three shunts (2 patients). At a mean follow-up of 15 months, the shunt revision rate of the patients was 0.4/year. One patient died of multiple brain abscesses and 6 patients remain severely disabled. The poor outcome may also be related to the original IVH as well as the multiloculated hydrocephalus. The study also shows that patients with post-haemorrhagic hydrocephalus, who develop a shunt infection due to gram-negative organisms and in whom the CSF fails to be cleared of the infection following 12 days of external drainage appear to be at risk of developing multiloculated hydrocephalus.