Clinical Factors Associated with Cutaneous Cerebrospinal Fluid Leakage in Infants Who Underwent a Ventriculoperitoneal Shunt Surgery

Abstract

Objective The aim of the study is to determine the factors related to fetal maturity and clinical parameters that may be involved in the development of skin cerebrospinal fluid leakage.

Methods This study evaluated 72 infants undergoing ventriculoperitoneal (VP) shunt between 2004 and 2008 at the Odilon Behrens Municipal Hospital. All children were treated by the same surgeon, and the clinical data concerning weight, age, and percentile, as well as hemoglobin levels, were collected from medical records and duly noted in proper protocols.

Results A tendency toward a high incidence of fistula could be observed in children born with a weight percentile of less than 10 (p = 0.06), and an even higher incidence could be identified in children who underwent surgery before 1 month of life (p < 0.05). Other parameters showed no significant difference in the comparison between children with and without cerebrospinal leakage.

Conclusion The chronological age and the degree of intrauterine nutrition are determining factors in cerebrospinal fluid leakage in infants and may well influence the incidence of wound complications after a VP shunt.

Resumo

Objetivos Determinar fatores clínicos e de maturidade fetal que possam estar envolvidos no desenvolvimento de fístulas cutâneas pós-operatórias.

Métodos Foram avaliados 72 lactentes submetidos a derivação ventriculoperitoneal no Hospital Municipal Odilon Behrens no período de 2004 a 2008. Os dados clínicos e laboratoriais ao nascimento e à cirurgia foram coletados dos prontuários e anotados em protocolos próprios.

Resultados Houve uma tendência a ocorrência de fístulas em crianças nascidas com percentil de peso abaixo de 10 (p = 0,06) e maior incidência em crianças operadas antes de um mês de vida (p < 0,05). Os demais parâmetros não foram significativos.

Conclusão A idade cronológica e o grau de nutrição intrauterina são fatores envolvidos na formação de fístulas liquóricas em recém-nascidos, tendo impacto na prevalência de complicações nas feridas de lactentes submetidos a derivação ventriculoperitoneal.

Keywords

hydrocephalus - wound healing - ventriculoperitoneal shunt

Palavras-chave

hidrocefalia - cicatrização - derivação ventriculoperitoneal

• References

• 1 Jeelani NU, Kulkarni AV, Desilva P, Thompson DN, Hayward RD. Postoperative cerebrospinal fluid wound leakage as a predictor of shunt infection: a prospective analysis of 205 cases. Clinical article. J Neurosurg Pediatr 2009; 4 (2) 166-169
• 2 Rotim K, Miklic P, Paladino J, Melada A, Marcikic M, Scap M. Reducing the incidence of infection in pediatric cerebrospinal fluid shunt operations. Childs Nerv Syst 1997; 13 (11–12) 584-587
• 3 Kulkarni AV, Drake JM, Lamberti-Pasculli M. Cerebrospinal fluid shunt infection: a prospective study of risk factors. J Neurosurg 2001; 94 (2) 195-201
• 4 Campos AC, Branco AB, Matias JE, Campos LF. Nutritional therapy and digestive tract fistulas [in Spanish]. Acta Gastroenterol Latinoam 2007; 37 (2) 118-125
• 5 Davis SE, Levy ML, McComb JG, Masri-Lavine L. Does age or other factors influence the incidence of ventriculoperitoneal shunt infections?. Pediatr Neurosurg 1999; 30 (5) 253-257
• 6 Rohde V, Weinzierl M, Mayfrank L, Gilsbach JM. Postshunt insertion CSF leaks in infants treated by an adjustable valve opening pressure reduction. Childs Nerv Syst 2002; 18 (12) 702-704
• 7 Korinth MC, Gilsbach JM. What is the ideal initial valve pressure setting in neonates with ventriculoperitoneal shunts?. Pediatr Neurosurg 2002; 36 (4) 169-174
• 8 Lubchenco LO, Hansman C, Boyd E. Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks. Pediatrics 1966; 37 (3) 403-408
• 9 Marques RM, Marcondes E, Berquo E, Prandi R, Yunes J. Crescimento e desenvolvimento pubertário em crianças e adolescentes brasileiros: altura e peso. São Paulo, Brazil: Brasileira de Ciências; 1982
• 10 Boop FA. Posthemorrhagic Hydrocephalus of prematurity. In: Cinalli G, Maixner WJ, Saint-Rose C, , eds. Pediatric Hydrocephalus. Italy: Springer; 2004: 121-131
• 11 Frim DM, Scott RM, Madsen JR. Surgical management of neonatal hydrocephalus. Neurosurg Clin N Am 1998; 9 (1) 105-110
• 12 Sekhar LN, Moossy J, Guthkelch AN. Malfunctioning ventriculoperitoneal shunts. Clinical and pathological features. J Neurosurg 1982; 56 (3) 411-416
• 13 Broughton II G, Janis JE, Attinger CE. Wound healing: an overview. Plast Reconstr Surg 2006; 117 (7, Suppl): 1e-S-32e
• 14 Taylor AG, Peter JC. Advantages of delayed VP shunting in post-haemorrhagic hydrocephalus seen in low-birth-weight infants. Childs Nerv Syst 2001; 17 (6) 328-333
• 15 Cass DL, Bullard KM, Sylvester KG, Yang EY, Longaker MT, Adzick NS. Wound size and gestational age modulate scar formation in fetal wound repair. J Pediatr Surg 1997; 32 (3) 411-415
• 16 Efimov EA. Comparison of healing of full-thickness wounds in newborn and sexually mature rats. Bull Exp Biol Med 1968; 65 (6) 661-663
• 17 Adzick NS, Harrison MR, Glick PL , et al. Comparison of fetal, newborn, and adult wound healing by histologic, enzyme-histochemical, and hydroxyproline determinations. J Pediatr Surg 1985; 20 (4) 315-319
• 18 Viljanto J, Raekallio J. Wound healing in children as assessed by the CELLSTIC method. J Pediatr Surg 1976; 11 (1) 43-48
• 19 Coelho-Lemos IC, Campos AC, de Almeida M , et al. In utero malnutrition influences wound healing of newborn rats as measured by tensile strength and collagen deposition. JPEN J Parenter Enteral Nutr 2004; 28 (4) 241-244 , discussion 245
• 20 Babuccu O, Kalayci M, Peksoy I, Kargi E, Cagavi F, Numanoğlu G. Effect of cerebrospinal fluid leakage on wound healing in flap surgery: histological evaluation. Pediatr Neurosurg 2004; 40 (3) 101-106