腹腔-脳室シャント合併症における感染と機械的機能不全の明確な臨床像

Introduction Ventriculoperitoneal shunt complications, particularly infection and mechanical dysfunction, represent major causes of morbidity and revision surgery in patients with hydrocephalus. Objective This study aimed to evaluate our single-center experience with ventriculoperitoneal shunt revisions and to compare shunt infection and mechanical shunt dysfunction in order to identify institution-specific clinical, laboratory, and cerebrospinal fluid (CSF) characteristics that may facilitate differential diagnosis. Results Among the patients, 140 (35.9%) were diagnosed with ventriculoperitoneal shunt infection, while 250 (64.1%) had mechanical shunt dysfunction. Fever, elevated C-reactive protein (CRP) and white blood cell (WBC) levels, reduced CSF glucose, and increased CSF protein levels were significantly more frequent in the infection group (p<0.001). Shunt infections predominantly occurred in the early postoperative period, whereas mechanical shunt dysfunction was more commonly observed during the late postoperative period. Coagulase-negative staphylococci were the most frequently isolated pathogens in CSF cultures. Conclusion Ventriculoperitoneal shunt infection and mechanical shunt dysfunction demonstrate clearly distinct clinical and biochemical profiles. Early assessment of these parameters may facilitate more accurate differentiation and support rational clinical decision-making.