Multifocal intraparenchymal hemorrhages after ventriculoperitoneal shunt surgery in infants

Clinical article

Jung Won Choi M.D.1, Seung-Ki Kim M.D., Ph.D.1, Kyu-Chang Wang M.D., Ph.D.1, Ji Yeoun Lee M.D., Ph.D.1, Jung-Eun Cheon M.D., Ph.D.2, and Ji Hoon Phi M.D.1
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  • 1 Division of Pediatric Neurosurgery and
  • | 2 Department of Diagnostic Radiology, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Object

Ventriculoperitoneal (VP) shunt surgery is the most common treatment for hydrocephalus. In certain situations, uncommon complications can occur after shunting procedures. The authors undertook this study to analyze the clinical characteristics of pediatric patients who developed multifocal intraparenchymal hemorrhages (MIPHs) as a complication of shunt surgery. The authors also analyzed the risk factors for MIPH in a large cohort of patients with hydrocephalus.

Methods

This study included all pediatric patients (age < 18 years) who underwent VP shunt surgery at the authors' institution between January 2001 and December 2012. During this period, 507 VP shunt operations were performed in 330 patients. Four of these patients were subsequently diagnosed as having MIPH. The authors analyzed the clinical characteristics of these patients in comparison with those of the entire group of shunt-treated patients.

Results

The incidence of MIPH was 1.2% (4 of 330 cases) for all pediatric patients who underwent VP shunt placement but 2.9% (4 of 140 cases) for infants less than 1 year old. When the analysis was limited to patients whose corrected age was less than 3 months, the incidence was 5.3% (4 of 76 cases). Of the 4 patients with MIPH, 2 were male and 2 were female. Their median age at surgery was 54 days (range 25–127 days), and in all 4 cases, the patients' corrected age was less than 1 month. Three patients were preterm infants, whereas one patient was full-term. None of these patients had a prior history of intracranial surgery (including CSF diversion procedures). All showed severe hydrocephalus during the preoperative period. Their clinical courses as patients with MIPH were comparatively favorable, despite the radiological findings.

Conclusions

MIPH is a rare but not negligible complication of VP shunt surgery. This complication might be a unique phenomenon in infants, especially young, preterm infants with severe hydrocephalus. Moreover, the absence of previous intracranial procedures might be one of the risk factors for this complication. The rapid alteration of brain conditions in the setting of immaturity might cause MIPH. To prevent this complication, the authors recommend that pressure settings of programmable valves should be gradually adapted to the target pressure.

Abbreviations used in this paper:

EDH = epidural hemorrhage; GA = gestational age; GMH = germinal matrix hemorrhage; INR = international normalized ratio; IVH = intraventricular hemorrhage; MIPH = multifocal intraparenchymal hemorrhage; SAH = subarachnoid hemorrhage; SDH = subdural hemorrhage; VP = ventriculoperitoneal.

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  • 1

    Alcázar L, , Alfaro R, , Tamarit M, , Gómez-Angulo JC, , Ortega JM, & Aragonés P, et al.: Delayed intracerebral hemorrhage after ventriculoperitoneal shunt insertion. Case report and literature review. Neurocirugia (Astur) 18:128133, 2007

    • Search Google Scholar
    • Export Citation
  • 2

    Balasubramaniam J, & Del Bigio MR: Animal models of germinal matrix hemorrhage. J Child Neurol 21:365371, 2006

  • 3

    Borgbjerg BM, , Gjerris F, , Albeck MJ, , Hauerberg J, & Børgesen SE: Frequency and causes of shunt revisions in different cerebrospinal fluid shunt types. Acta Neurochir (Wien) 136:189194, 1995

    • Search Google Scholar
    • Export Citation
  • 4

    Burstein J, , Papile L, & Burstein R: Subependymal germinal matrix and intraventricular hemorrhage in premature infants: diagnosis by CT. AJR Am J Roentgenol 128:971976, 1977

    • Search Google Scholar
    • Export Citation
  • 5

    Derdeyn CP, , Delashaw JB, , Broaddus WC, & Jane JA: Detection of shunt-induced intracerebral hemorrhage by postoperative skull films: a report of two cases. Neurosurgery 22:755757, 1988

    • Search Google Scholar
    • Export Citation
  • 6

    Fukamachi A, , Koizumi H, & Nukui H: Postoperative intracerebral hemorrhages: a survey of computed tomographic findings after 1074 intracranial operations. Surg Neurol 23:575580, 1985

    • Search Google Scholar
    • Export Citation
  • 7

    Kubokura T, , Nishimura T, , Koyama S, , Sanno N, & Tsubone K: [Delayed intracerebral hemorrhage following VP shunt operation.]. No Shinkei Geka 16:5 Suppl 523527, 1988. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 8

    Kulkarni AV, , Drake JM, , Armstrong DC, & Dirks PB: Measurement of ventricular size: reliability of the frontal and occipital horn ratio compared to subjective assessment. Pediatr Neurosurg 31:6570, 1999

    • Search Google Scholar
    • Export Citation
  • 9

    Lund-Johansen M, , Svendsen F, & Wester K: Shunt failures and complications in adults as related to shunt type, diagnosis, and the experience of the surgeon. Neurosurgery 35:839844, 1994

    • Search Google Scholar
    • Export Citation
  • 10

    Mascalchi M: Delayed intracerebral hemorrhage after CSF shunt for communicating “normal-pressure” hydrocephalus. Case report. Ital J Neurol Sci 12:109112, 1991

    • Search Google Scholar
    • Export Citation
  • 11

    Misaki K, , Uchiyama N, , Hayashi Y, & Hamada J: Intracerebral hemorrhage secondary to ventriculoperitoneal shunt insertion—four case reports. Neurol Med Chir (Tokyo) 50:7679, 2010

    • Search Google Scholar
    • Export Citation
  • 12

    Nakamura Y, , Okudera T, & Hashimoto T: Microvasculature in germinal matrix layer: its relationship to germinal matrix hemorrhage. Mod Pathol 4:475480, 1991

    • Search Google Scholar
    • Export Citation
  • 13

    Okazaki M, , Fukuhara T, & Namba Y: Delayed germinal matrix hemorrhage induced by ventriculoperitoneal shunt insertion for congenital hydrocephalus. Report of 2 cases. J Neurosurg Pediatr 12:6770, 2013

    • Search Google Scholar
    • Export Citation
  • 14

    Papile LA, , Burstein J, , Burstein R, & Koffler H: Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 92:529534, 1978

    • Search Google Scholar
    • Export Citation
  • 15

    Savitz MH, & Bobroff LM: Low incidence of delayed intracerebral hemorrhage secondary to ventriculoperitoneal shunt insertion. J Neurosurg 91:3234, 1999

    • Search Google Scholar
    • Export Citation
  • 16

    Tuli S, , Drake J, , Lawless J, , Wigg M, & Lamberti-Pasculli M: Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg 92:3138, 2000

    • Search Google Scholar
    • Export Citation
  • 17

    Udvarhelyi GB, , Wood JH, , James AE Jr, & Bartelt D: Results and complications in 55 shunted patients with normal pressure hydrocephalus. Surg Neurol 3:271275, 1975

    • Search Google Scholar
    • Export Citation
  • 18

    Wong JM, , Ziewacz JE, , Ho AL, , Panchmatia JR, , Bader AM, & Garton HJ, et al.: Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery. Neurosurg Focus 33:5 E13, 2012

    • Search Google Scholar
    • Export Citation

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