Document Detail


Long-term outcome of hydrocephalus management in myelomeningoceles.
MedLine Citation:
PMID:  12764629     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The cerebrospinal fluid (CSF) shunt remains an important ongoing management problem in myelomeningocele (MMC) patients. We reviewed the long-term shunt treatment outcome in a prospectively followed group of MMC patients from a single institution. METHOD: Patients prospectively entered into a hydrocephalus database with a diagnosis of MMC from the years 1987 to 1996 were selected. All data was verified from the medical records and additional details about the shunt surgery were collected. The outcome of shunt failure was categorized as shunt obstruction, shunt infection, presence of loculated ventricles, overdrainage, and other. All deaths were recorded and causation identified. Univariate analysis for shunt failure risk factors was accomplished using Log rank statistics. Multivariable analysis was performed for each repeated failure level using a conditional Cox regression model. RESULTS: One hundred and twenty (64%) out of 189 MMC patients experienced a first shunt failure with a median time of 303 days; 29 (24%) of the failures were due to shunt infection (the procedure infection rate being 15%). Sixty-one patients experienced a second shunt failure, 38 a third and 36 had four or more. Multivariable analysis of risk factors failed to demonstrate any clear risk factors for either first or subsequent shunt failure. Fifteen patients died, 13 from either shunt or Chiari 1 complications. CONCLUSION: Shunt complications remain an important cause of morbidity and mortality in MMC patients, particularly shunt infection.
Authors:
Sagun Tuli; James Drake; Maria Lamberti-Pasculli
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Publication Detail:
Type:  Journal Article     Date:  2003-05-23
Journal Detail:
Title:  Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery     Volume:  19     ISSN:  0256-7040     ISO Abbreviation:  Childs Nerv Syst     Publication Date:  2003 Jun 
Date Detail:
Created Date:  2003-07-11     Completed Date:  2003-09-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8503227     Medline TA:  Childs Nerv Syst     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  286-91     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, The Brigham and Women's Hospital, Harvard Medical School, One Brookline Place, Suite 227, Brookline, MA 02445, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Cerebrospinal Fluid Shunts / instrumentation
Child
Child, Preschool
Cohort Studies
Equipment Failure / statistics & numerical data
Female
Follow-Up Studies
Humans
Hydrocephalus / etiology*,  surgery*
Infant
Infant, Newborn
Male
Meningomyelocele / complications*,  surgery*
Postoperative Complications / mortality
Prospective Studies
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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