Revision rate of pediatric ventriculoperitoneal shunts after 15 years

Clinical article

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Object

Ventriculoperitoneal (VP) shunt placement remains the mainstay treatment for pediatric hydrocephalus. These devices have a relatively high complication and failure rate, often requiring multiple revisions. The authors present a single institution's experience of pediatric patients treated with VP shunts. With an average follow-up time of 20 years, this study is among the longest reports of VP shunt revision in the literature to date. Hydrocephalus origins, shunt revision rates, and causes of shunt failure are described. Patients who underwent their first shunt revision more than 10 years after initial shunt placement were also explored.

Methods

A retrospective chart review was performed on all pediatric patients who underwent VP shunt placement from January 1990 through November 1996 at the University of Rochester Medical Center. Only patients who had at least 15 years of follow-up since their initial shunting procedure were included.

Results

A total of 234 procedures were performed on 64 patients, with a mean follow-up of 19.9 years. Patients ranged from a few days to 17.2 years old when they received their original shunt, with a median age of 4 months; 84.5% of the patients required 1 or more shunt revisions and 4.7% required 10 or more. Congenital defects, Chiari Type II malformations, tumors, and intraventricular hemorrhage were the most common causes of hydrocephalus. Overall, patients averaged 2.66 revisions, with proximal (27%) and distal (15%) catheter occlusion, disconnection (11%), and infection (9%) comprising the most common reasons for shunt malfunction. Notably, 12.5% of patients did not require their first shunt revision until more than 10 years after initial device placement, a previously undescribed finding due to the short follow-up duration in previous studies.

Conclusions

This long-term retrospective analysis of pediatric VP shunt placement revealed a relatively high rate of complications with need for shunt revision as late as 17 years after initial placement. Catheter occlusion represented a significant percentage of shunt failures. Cerebrospinal fluid shunting has a propensity for mechanical failure and patients with VP shunts should receive follow-up through the transition to adulthood.

Abbreviations used in this paper:CM = Chiari malformation; IVH = intraventricular hemorrhage; VP = ventriculoperitoneal.

Article Information

* Dr. Stone and Mr. Walker contributed equally to this work.

Address correspondence to: Jonathan J. Stone, M.D., School of Medicine and Dentistry, University of Rochester, 601 Elmwood Avenue, Box 670, Rochester, New York 14642. email: jonathanjaystone@gmail.com.

Please include this information when citing this paper: published online October 26, 2012; DOI: 10.3171/2012.9.PEDS1298.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Bar graph illustrating the percentage of patients receiving between 0 and 5, or more than 10 VP shunt revisions over an average follow-up duration of 20 years.

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    Kaplan-Meier survival curve illustrating 20-year cumulative (cum) survival after initial VP shunt placement. More than half of the failures occurred within the 1st year. After the initial early failure, there was a steady decline in survivability extending past 15 years.

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    Representation of causes for shunt failure over an average follow-up of 20 years. Equipment failure (21%) included disconnection (11%), tubing break (4%), or catheter migration (6%). The “other” category (18%) included unknown (12%), nonabsorbing peritoneum (2%), underdrainage (2%), and independence failure (2%). The catheter clogged category (52%) included proximal (27%), distal (15%), valve (8%), or complete occlusion (2%).

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