Time-related patterns of ventricular shunt failure

Abstract

Proximal obstruction is reported to be the most common cause of ventriculoperitoneal (VP) shunt failure, suggesting that imperfect ventricular catheter placement and inadequate valve mechanisms are major causes. This study retrospectively examined patterns of shunt failure in 128 consecutive patients with symptoms of shunt malfunction over a 2-year period. Factors analyzed included site of failure, time from shunt placement or last revision to failure, age of patient at time of failure, infections, and primary etiology of the hydrocephalus. One hundred of these patients required revisions; 14 revisions were due to infections. In this series there was a higher incidence of distal (43%) than of proximal (35%) failure. The difference was not statistically significant when the overall series was considered; however, when factoring time to failure as a variable, marked differences were noted regardless of the underlying cause of hydrocephalus or the age of the patient. Of the 49 patients needing a shunt revision or replacement within 2 years of the previous operation, 50% had proximal malfunction, 14% distal, and 10% had malfunctions attributable directly to the valve itself. Also, 12 of the 14 infections occurred during this time interval. In sharp contrast, of the 51 patients having shunt failure from 2 to more than 12 years after the previous procedure, 72% had distal malfunction, 21% proximal, and only 6% had a faulty valve or infection. This difference between time to failure for proximal versus distal failures was statistically significant (P < 0.00001 for both Student's t-test and non-parametric Mann-Whitney U-test).(ABSTRACT TRUNCATED AT 250 WORDS)

Laparotomy versus Laparoscopic Placement of Distal Catheter in Ventriculoperitoneal Shunt Procedure

“…However, recently, only two neurosurgeons are required for the operation and much shortened procedure duration has been achieved. Other studies report a relatively higher infection rates in concurrent operations with the general surgeons 15) . However, our study showed no statistically significant differences.…”

An Unusual Case of Headache Presenting to Emergency Department: Late Onset Ventriculo-Peritoneal Shunt Fracture

“…The majority of these were seen in the neck (48%), followed by the abdomen (28%) and the chest (24%) [4]. Proximal VP shunt malfunction commonly occurs in the first 2 years of shunt placement while distal shunt malfunction is generally seen 2 years following surgery [5]. The interval from shunt insertion to shunt-series abnormality has been reported to be greater than 2 years in 85% of cases [4].…”

On-Off Malfunctıon In A Pedıatrıc Shunt: A Case Report

“…The occlusion is multifactorial in origin. Choroid plexus, brain debris, fibrin, clotted blood, and/ or developing granulation tissues can totally or partially block the ventricular catheter (Blount, 1993;Sainte-Rose, 1993;Kast, 1994;Takahashi, 1998).…”

“…Shunt may be obstructed at the ventricular part, within the pumping device, and/or at the distal catheter. Proximal shunt obstruction due to mechanical occlusion of the ventricular catheter is the most common cause of shunt malfunction with a 30% rate (Sainte-Rose, 1991;Sainte-Rose, 1993;Kast, 1994;Takahashi, 1998). The occlusion is multifactorial in origin.…”