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Surgical outcome of the shunt: 15-year experience in a single institution

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Abstract

Purpose

Surgical outcome after shunt insertion in pediatric hydrocephalus can vary greatly. Although first shunt survival rates and complications have been studied by several teams, much less is known about survival and complications of subsequent systems. The goals of this study were to evaluate the surgical outcome in a series of pediatric patients followed for a long time and establish the differences between first and subsequent extracranial shunt survival and complications.

Methods

We undertook a retrospective study in pediatric patients treated with ventriculoperitoneal shunts between 2000 and 2015 at our institution. Surgical outcome was assessed, and different shunt survival curves were studied with Kaplan-Meier. Complications related to each shunt failure were examined and compared.

Results

A total of 166 patients underwent 425 procedures, with a mean follow-up period of 93 months. The median number of shunt revision surgeries was 2. Shunt survival rates were better with the first shunt compared to those with the subsequent shunts. The main complication necessitating system revision surgery was overdrainage, the frequency of proximal and distal dysfunctions was similar in all the shunt failures, and isolated ventricle and infection were more frequent in younger patients. Shunt-related infections accounted for 7 % of the procedures, and the shunt independence rate was 10 %.

Conclusions

The frequency of complications related to shunt failure in pediatric patients changes during follow-up. A strict protocol of overdrainage detection and active treatment could explain the need for repeat surgeries and the progressively shorter shunt survival time in our series.

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Authors and Affiliations

  1. Department of Neurosurgery, Hospital Regional Universitario de Málaga, Málaga, Spain

    Sara Iglesias, Bienvenido Ros, Álvaro Martín, Antonio Carrasco, Miguel Segura, Andrea Delgado & Miguel Ángel Arráez

  2. Department of Statistics, Universidad de Málaga, Málaga, Spain

    Francisca Rius

Authors
  1. Sara Iglesias
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  2. Bienvenido Ros
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  3. Álvaro Martín
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  4. Antonio Carrasco
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  5. Miguel Segura
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  6. Andrea Delgado
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  7. Francisca Rius
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  8. Miguel Ángel Arráez
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Corresponding author

Correspondence to Sara Iglesias.

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The authors report no conflict of interest concerning the materials or methods used in this paper. No external funds were received for this study.

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Iglesias, S., Ros, B., Martín, Á. et al. Surgical outcome of the shunt: 15-year experience in a single institution. Childs Nerv Syst 32, 2377–2385 (2016). https://doi.org/10.1007/s00381-016-3206-z

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  • DOI: https://doi.org/10.1007/s00381-016-3206-z

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