Late pediatric ventriculoperitoneal shunt failures: a Singapore tertiary institution's experience

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The introduction of ventriculoperitoneal shunts changed the way hydrocephalus was treated. Whereas much is known about the causes of shunt failure in the first few years, there is a paucity of data in the literature regarding the cause of late shunt failures. The authors conducted a study to find out the different causes of late shunt failures in their institution.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A 10-year retrospective study of all the patients who were treated in the authors' hospital between 2006 and 2015 was conducted. Late shunt failures included those in patients who had to undergo shunt revision more than 5 years after their initial shunt insertion. The patient's notes and scans were reviewed to obtain the age and sex of the patient, the time it took for the shunt to fail, the reason for failure, and the patient's follow-up.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Forty-six patients in the authors' institution experienced 48 late shunt failures in the last 10 years. Their ages ranged from 7 to 26 years (12.23 ± 4.459 years [mean ± SD]). The time it took for the shunts to fail was between 6 and 24 years (mean 10.25 ± 3.77 years). Reasons for failure resulting in shunt revision include shunt fracture in 24 patients (50%), shunt blockage in 14 patients (29.2%), tract fibrosis in 6 patients (12.5%), shunt dislodgement in 2 patients (4.2%), and shunt erosion in 2 patients (4.2%). Postoperative follow-up for the patients ranged from 6 to 138 months (mean 45.15 ± 33.26 months).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Late shunt failure is caused by the effects of aging on the shunt, and the complications are different from early shunt failure. A large proportion are complications associated with shunt calcification. The authors advocate a long follow-up for pediatric patients with shunts in situ to monitor them for various causes of late shunt failure.</jats:p></jats:sec>

Shunt fracture as a sequela of cervical spine manipulation: a case report

“…Shunt fractures result from calcification, fibrosis, and tethering within tissues, which predispose the catheter to rupture when biomechanical tension is applied [ 3 ]. A follow-up study showed that aged implants become fragile within an average of 5 years after the appearance of calcification in pediatric patients [ 4 ]. Tubing fractures occur most often in children when their height increases rapidly.…”

Ventriculoperitoneal Shunt Disconnection, Shunt Migration, and Silent Bowel Perforation in a 10-Year-Old Boy

“…[13] The requirement of shunt revisions varies from 6 months to 20 years after the VPS insertion or last shunt revision. [123] Bowel perforation is also occurring in up to 2% of the cases, and most of the time, the bowel perforation is without peritonitis. Colon is the most common site for hollow viscus perforation by peritoneal catheter, although perforation of the small bowel, stomach, and other hollow viscus has also been reported.…”

“…Ventriculoperitoneal shunt (VPS) insertion for the treatment of hydrocephalus is associated with several complications, including infections, mechanical failure, obstruction, bowel perforation with or without extrusion through natural orifices, nonvisceral perforation, shunt migrations, and shunt disconnection. [123] Colon is the most common site for hollow viscus perforation by the peritoneal catheter, but perforation of the small bowel, stomach, and other hollow viscus has also been reported. [1345] Disconnection of VPS catheter is also a well-known complication and is observed more in multicomponent shunt systems.…”

Permanent Visual Impairment due to Delayed Diagnosis of Shunt Malfunction in Case of Lack of Typical Features of Increased Intracranial Pressure and Unchanged Ventricular Size

“…Ventriculoperitoneal (V-P) shunting is the most widespread used treatment for patients with hydrocephalus. However, some studies have shown that in a pediatric population for shunts, the V-P shunt malfunction rate can be 41–58% [1], including shunt catheter blockage, infection, and over- or under-drainage. The usual clinical presentation of V-P shunt malfunction was headache, vomiting, and dizziness [2].…”