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[Complications of cerebrospinal fluid shunt]
L Gómez López1, C Luaces Cubells, J M Costa Clará
1Servicio de Pediatría, Unitat Integrada Hospital Clínic-Sant Joan de Déu, Universitat de Barcelona.
Insights
Ventriculo-peritoneal shunts are crucial for treating hydrocephalus but can malfunction due to mechanical issues or infection. Early detection and appropriate management, including surgical intervention and prophylactic antibiotics, are key to improving patient outcomes.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Infectious Diseases
Context:
- Ventriculo-peritoneal shunts are a primary treatment for hydrocephalus.
- Shunt malfunction presents significant challenges in pediatric neurosurgery.
- Understanding complication patterns is vital for optimizing patient care.
Purpose:
- To investigate the incidence, presentation, and management of ventriculo-peritoneal shunt malfunction in children.
- To analyze the clinical and microbiological aspects of shunt failure.
- To evaluate treatment strategies for mechanical and infectious shunt complications.
Summary:
- This retrospective study analyzed 37 children with malfunctioning shunts, finding mechanical causes in 68% and infection in 32%. Common symptoms included vomiting, fever, and headache.
- Mechanical dysfunction often required shunt revision within 24 hours, while infectious cases were managed with external shunts.
- Staphylococcus was the most common pathogen in infected shunts. Over half of malfunctions occurred more than six months post-insertion.
Impact:
- Highlights the significant rates of mechanical and infectious complications associated with ventriculo-peritoneal shunts.
- Emphasizes the need for meticulous surgical technique, asepsis, and prophylactic antibiotics to minimize shunt-related morbidity.
- Provides insights into timely management strategies for different types of shunt failure, informing clinical practice and improving outcomes for hydrocephalus patients.
Objective:
The objective of this study was to know the incidence, mode of presentation, clinical and microbiological aspects, as well as the management of ventriculo-peritoneal shunt malfunction.
Patients And Methods:
A retrospective study was carried out where thirty-seven children with malfunctioning shunts were studied. The mechanical causes of shunt malfunction included disconnection, fracture and obstruction, while infection was considered as either a clinical or analytical change (blood and/or CSF).
Results:
The mean age of the patients was 5.5 years. The most common indication for the insertion of the ventriculoperitoneal shunt was congenital hydrocephalus. The average stay in the ICU was 8.2 days. Mechanical dysfunction was detected in 25 patients (68%) and infectious etiology in 12. The most common clinical manifestations were vomiting, fever and headache. CSF biochemical alteration was found in 8 of the infected group. Staphylococcus was isolated in six of the 8 cases. The ventriculoperitoneal shunt was changed during the first 24 hours in 17 of 25 patients (68%) with mechanical malfunction, while 11 cases with an infective cause (92%) were managed with an external shunt. The interval between the insertion of the ventriculoperitoneal shunt and the malfunction was over 6 months in 20 cases (54%).
Conclusions:
Ventriculoperitoneal shunts are the main method for treating hydrocephaly, although they are not without complications which may require surgical procedures. Appropriate surgical technique, asepsis, as well as prophylactic antibiotics are essential to decrease the incidence of complications.