Document Detail


Outcome analysis of initial neonatal shunts: does the valve make a difference?
MedLine Citation:
PMID:  12422042     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Ventriculoperitoneal shunts have one of the highest complication rates of all neurosurgical procedures. The purpose of this study was to identify factors associated with malfunction of shunts placed in infants with neonatal hydrocephalus, with the goal of maximizing long-term shunt survival. METHODS: We performed a retrospective chart review of 200 consecutive patients less than 1 year old who underwent primary intracranial shunt placement for hydrocephalus by one of two experienced pediatric neurosurgeons at a single institution. A multivariate analysis was conducted to identify variables that were statistically independent predictors of a shunt malfunction or problem. RESULTS: Adequate data were available for 158 patients, with a mean follow-up of 39.8 months (range 6-99 months). Variables tested for independent prediction of shunt revision included the etiology of the hydrocephalus, gestation period, age at shunt placement, surgeon, ventricular catheter entry site and valve opening pressure. Frontal versus occipital catheter entry site was not associated with a different revision rate. The only significant controllable factor associated with shunt malfunction was the valve opening pressure. The revision rate per year of follow-up was 4 times higher for patients with no valve or a low-pressure valve than for patients with a medium- or high-pressure valve. CONCLUSIONS: This retrospective review demonstrated that the valve opening pressure is an important component of the shunt complication rate. A prospective multicenter randomized trial is warranted to further evaluate the conclusions of this study.
Authors:
Shenandoah Robinson; Bruce A Kaufman; T S Park
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric neurosurgery     Volume:  37     ISSN:  1016-2291     ISO Abbreviation:  Pediatr Neurosurg     Publication Date:  2002 Dec 
Date Detail:
Created Date:  2002-11-07     Completed Date:  2003-03-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9114967     Medline TA:  Pediatr Neurosurg     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  287-94     Citation Subset:  IM    
Copyright Information:
Copyright 2002 S. Karger AG, Basel
Affiliation:
St Louis Children's Hospital, Washington University, St Louis, Mo, USA. shenandoah.robinson@uhhs.com
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Cerebrospinal Fluid Pressure*
Drainage / adverse effects
Equipment Design
Equipment Failure
Humans
Hydrocephalus / surgery*
Infant
Multivariate Analysis
Outcome Assessment (Health Care)
Reoperation
Retrospective Studies
Ventriculoperitoneal Shunt / adverse effects,  instrumentation*

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


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