The risk of abdominal operations in children with ventriculoperitoneal shunts

Pittman, Thomas; Williams, Dianne; Weber, Thomas; Steinhardt, George F.; Tracy, Tom

doi:10.1016/0022-3468(92)90558-o

Cited by 36 publications

(18 citation statements)

References 6 publications

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“…Major intra-abdominal operations were implicated in the occurrence of CSF pseudocysts [8]. However, another series [19] reported no infection and no pseudocysts after 44 abdominal (gastrointestinal and urological) operations in 37 patients with VP shunts. However, there were no cases of prior abdominal surgery in our series.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Cerebrospinal Fluid Pseudocyst: A Complication of Ventriculoperitoneal Shunt in Children

1998

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The present paper is a retrospective analysis of 27 consecutive patients, treated for abdominal cerebrospinal fluid (CSF) pseudocyst at the Children’s Memorial Hospital in the years 1991–1996. This series is compared to the previous experience from our institution. Treatment consisted of the removal of the ventriculoperitoneal (VP) shunt and placement of an external ventricular drain. Antibiotics were administered intravenously for 10 days. The cysts were aspirated intraoperatively in 9 patients and postoperatively with ultrasound guidance in 3 patients, while they resolved spontaneously in 15 others. In 21 of 27 cases (78%), the shunt could be reinserted into the abdomen in a new location. Four patients had a ventriculopleural shunt, and in 2 patients, a ventriculoatrial shunt was inserted. Forty-four percent of the patients had a positive culture on presentation. The positive culture rate was 77% for those 4 years old and younger and only 28% for those aged 5 and above (p = 0.03). We conclude that abdominal CSF pseudocysts are resolved by externalizing the shunt. A VP shunt can be safely reinserted in the majority of the patients. Infection, while an important factor, is not likely to account for all cases of pseudocyst.

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Section: Discussionmentioning

confidence: 99%

Abdominal Cerebrospinal Fluid Pseudocyst: A Complication of Ventriculoperitoneal Shunt in Children

1998

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“…There are a number of reports on the risk of shunt infection with elective or concomitant abdominal surgery with most suggesting that there is no increased risk. 8,16,20 Surprisingly, there are no reports in the literature that directly address the risk of shunt malfunction or infection after elective intradural cranial or spinal surgery. Such surgery can expose the hardware for prolonged period of time or introduce pathogens, blood, debris, or air into the CSF, which can lead to malfunction or infection.…”

Section: G T Venable Et Almentioning

confidence: 99%

What is the risk of a shunt malfunction after elective intradural surgery?

Venable¹,

Green²,

Smalley³

et al. 2015

PED

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A n estimated 36,000 shunt-related operations are performed annually. 5 The well-known early and late complications and malfunctions from shunts result in great burdens for patients, their families, and health care providers. The estimated annual cost of treating pediatric hydrocephalus is 1.4 to 2.0 billion dollars annually. 22 A recent study in a pediatric population showed that 84.5% of patients required at least 1 shunt revision, and 4.7% required 10 or more, resulting in an average of 2.66 revisions at a mean follow-up of 19.9 years.24 Al-Tamimi et al. reported that 12.9% of new shunts fail within 30 days and 28.8% fail within 1 year. Revised shunts fare even worse, with 20.7% failing within 30 days and 40.4% failing within 1 year.2 Though the rates vary from study to study, it is clear that an exceptionally high number of ventricular shunts will require at least 1 revision at some point. Much work has been done to elucidate risk factors for shunt failure, such as age, sex, race, socioeconomic status, presence of comorbidities, years with shunt, and the surgeon performing the operation, though the significance of these factors varies considerably between studies. 17,21,24,26,28,29 abbreviations LBCH = Le Bonheur Children's Hospital; VP = ventriculoperitoneal. School of Medicine and Biomedical Sciences, University at Buffalo, New York obJect Surgery for CSF diversion is the most common procedure performed by pediatric neurosurgeons. The failure rates for shunts remain frustratingly high, resulting in a burden to patients, families, providers, and healthcare systems. The goal of this study was to quantify the risk of a shunt malfunction in patients with an existing shunt who undergo an elective intradural operation. methods All elective intradural surgeries (cranial and spinal) at Le Bonheur Children's Hospital from January 2010 through June 2014 were reviewed to identify those patients who had a functional ventricular shunt at the time of surgery. Patient records were reviewed to collect demographic, surgical, clinical, radiological, and pathologic data, including all details related to any subsequent shunt revision surgery. The primary outcome was all-cause shunt revision (i.e., malfunction or infection) within 90 days of elective intradural surgery. results One hundred and fifty elective intradural surgeries were identified in 109 patients during the study period. There were 14 patients (12.8%, 13 male) who experienced 16 shunt malfunctions (10.7%) within 90 days of elective intradural surgery. These 14 patients underwent 13 craniotomies, 2 endoscopic fenestrations for loculated hydrocephalus, and 1 laminectomy for dorsal rhizotomy. Median time to failure was 9 days, with the shunts in half of our patients failing conclusions This is the first study to quantify the risk of a shunt malfunction after elective intradural surgery. The 90-day all-cause shunt failure rate (per procedure) was 10.7%, with half of the failures occurring within the first 5 postoperative days. Possible risk factors for shunt malfunct...

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“…To an increasing extent children with a VP shunt are undergoing planned surgical procedures unrelated to the shunt system. The risk of mechanical damage during operation can be neglected, whereas the risk of ascending infection of the drainage system has to be evaluated in any case [13,14].…”

Section: Discussionmentioning

confidence: 99%

Appendicitis in Children with a Ventriculoperitoneal Shunt

Pumberger¹,

Lobl²,

Geissler³

1998

Pediatr Neurosurg

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The presentation of an acute abdomen in children with a ventriculoperitoneal shunt requires skilful diagnostic workup. Apart from complications caused by the shunt, primary abdominal pathological conditions must be taken into consideration, particularly in the older child. A series of 6 children with a ventriculoperitoneal shunt had to be treated surgically for appendicitis. Their medical records were analyzed retrospectively. Despite difficulties with the initial diagnosis, the time from admission to final diagnosis and operation was relatively short. An accurate history, careful evaluation of the clinical signs and, above all, ultrasound of the abdomen were helpful in decision making. During the operation the shunts were left in place. Only 1 patient developed a cerebrospinal fluid pseudocyst in the early postoperative period, which made a conversion into a ventriculoatrial shunt necessary. No ascending infection occurred, even when the abdominal tip of the shunt came in close contact with the focus of inflammation. An acute abdomen due to shunt infection should be managed conservatively and by removal of the shunt from the abdomen, thus avoiding an unnecessary laparotomy. On the other hand, a primary intra-abdominal disease requires surgical treatment, during which the shunt system can be left in place.

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The risk of abdominal operations in children with ventriculoperitoneal shunts

Cited by 36 publications

References 6 publications

Abdominal Cerebrospinal Fluid Pseudocyst: A Complication of Ventriculoperitoneal Shunt in Children

Abdominal Cerebrospinal Fluid Pseudocyst: A Complication of Ventriculoperitoneal Shunt in Children

What is the risk of a shunt malfunction after elective intradural surgery?

Appendicitis in Children with a Ventriculoperitoneal Shunt

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