Incidence of and Causes for Ventriculoperitoneal Shunt Failure in Children Younger Than 2 Years: A Systematic Review

Abstract

Objectives Ventriculoperitoneal (VP) shunting is commonly used to treat pediatric hydrocephalus, but failure rates are high. VP shunt failure in children is mostly caused by infection and/or proximal/distal shunt obstruction. However, to our knowledge, no previous reviews have discussed this topic using only clinical studies when age-related data could be obtained. This systematic review aimed at reevaluating what is already known as the most common causes of shunt failure and to determine the incidence and causes of VP shunt failure during the first 2 years of life as a step to establish solid evidence-based guidelines to avoid VP shunt failure in infants.

Methods We performed a search using the search terms “Cerebrospinal Fluid Shunts” (Medical Subject Headings [MeSH]) AND failure [All Fields] AND (“humans” [MeSH] AND English [lang] AND “infant” [MeSH]). Only articles that specifically discussed VP shunt complications in children < 2 years were included.

Results We found that the most common causes of VP shunt failure in children < 2 years were shunt obstruction and infection, both observed in a range.

Conclusion VP shunt failure is very common in infants, mostly resulting from obstruction and infection. Future studies should focus on methods designed to avoid these complications or on alternative treatments for hydrocephalus.

Keywords

failure - infants - infection - obstruction - ventriculoperitoneal shunt

• References

• 1 Bakhsh A. CSF shunt complications in infants—an experience from Pakistan. Pediatr Neurosurg 2011; 47 (02) 93-98
• 2 Miranda P, Simal JA, Menor F, Plaza E, Conde R, Botella C. Initial proximal obstruction of ventriculoperitoneal shunt in patients with preterm-related posthaemorrhagic hydrocephalus. Pediatr Neurosurg 2011; 47 (02) 88-92
• 3 Garber ST, Riva-Cambrin J, Bishop FS, Brockmeyer DL. Comparing fourth ventricle shunt survival after placement via stereotactic transtentorial and suboccipital approaches. J Neurosurg Pediatr 2013; 11 (06) 623-629
• 4 Jernigan SC, Berry JG, Graham DA, Goumnerova L. The comparative effectiveness of ventricular shunt placement versus endoscopic third ventriculostomy for initial treatment of hydrocephalus in infants. J Neurosurg Pediatr 2014; 13 (03) 295-300
• 5 Di Rocco C, Massimi L, Tamburrini G. Shunts vs endoscopic third ventriculostomy in infants: are there different types and/or rates of complications? A review. Childs Nerv Syst 2006; 22 (12) 1573-1589
• 6 Guillaume D, Menezes A. Hydrocephalus in Chiari malformation and other craniovertebral junction abnormalities. In: Cerebrospinal Fluid Disorders. Boca Raton, FL: CRC Press; 2009: 300-317 . Available at: http://www.crcnetbase.com/doi/abs/10.3109/9781420016284-18
• 7 Rabinstein AA, Jr MPK. Year Book of Neurology and Neurosurgery e-book. Elsevier Health Sciences; 2011
• 8 Programmlinie 4: Deutsch-Arabische Forschungspartnerschaft - Al Tawasul - DAAD - Deutscher Akademischer Austauschdienst. Available at: https://www.daad.de/hochschulen/programme-regional/arabischer-raum/de/42005-programmlinie-deutsch-arabische-forschungspartnerschaft-al-tawasul/
• 9 Shannon CN, Acakpo-Satchivi L, Kirby RS, Franklin FA, Wellons JC. Ventriculoperitoneal shunt failure: an institutional review of 2-year survival rates. Childs Nerv Syst 2012; 28 (12) 2093-2099
• 10 Beez T, Sarikaya-Seiwert S, Bellstädt L, Mühmer M, Steiger H-J. Role of ventriculoperitoneal shunt valve design in the treatment of pediatric hydrocephalus—a single center study of valve performance in the clinical setting. Childs Nerv Syst 2014; 30 (02) 293-297
• 11 Turhan T, Ersahin Y, Dinc M, Mutluer S. Cerebro-spinal fluid shunt revisions, importance of the symptoms and shunt structure. Turk Neurosurg 2011; 21 (01) 66-73
• 12 Simon TD, Butler J, Whitlock KB. , et al; Hydrocephalus Clinical Research Network. Risk factors for first cerebrospinal fluid shunt infection: findings from a multi-center prospective cohort study. J Pediatr 2014; 164 (06) 1462-8.e2
• 13 Notarianni C, Vannemreddy P, Caldito G. , et al. Congenital hydrocephalus and ventriculoperitoneal shunts: influence of etiology and programmable shunts on revisions. J Neurosurg Pediatr 2009; 4 (06) 547-552
• 14 Kulkarni AV, Riva-Cambrin J, Butler J. , et al; Hydrocephalus Clinical Research Network. Outcomes of CSF shunting in children: comparison of Hydrocephalus Clinical Research Network cohort with historical controls: clinical article. J Neurosurg Pediatr 2013; 12 (04) 334-338
• 15 Riva-Cambrin J, Kestle JRW, Holubkov R. , et al; Hydrocephalus Clinical Research Network. Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study. J Neurosurg Pediatr 2016; 17 (04) 382-390
• 16 Griffith HB, Jamjoom AB. The treatment of childhood hydrocephalus by choroid plexus coagulation and artificial cerebrospinal fluid perfusion. Br J Neurosurg 1990; 4 (02) 95-100
• 17 Pople IK, Ettles D. The role of endoscopic choroid plexus coagulation in the management of hydrocephalus. Neurosurgery 1995; 36 (04) 698-701 ; discussion 701–702
• 18 Putnam TJ. Treatment of hydrocephalus by endoscopic coagulation of the choroid plexus—description of a new instrument and preliminary report of results. N Engl J Med 1934; 210: 1373-1376 . Available at: http://www.nejm.org/doi/full/10.1056/NEJM193406282102602
• 19 Turner R, Chahlavi A, Rasmussen P, Brody F. Laparoscopic revision of a ventriculoperitoneal shunt. J Laparoendosc Adv Surg Tech A 2004; 14 (05) 310-312
• 20 Warf BC. Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children. J Neurosurg 2005; 103 (6, Suppl): 475-481
• 21 Yavuz C, Demırtas S, Calıskan A. , et al. Reasons, procedures, and outcomes in ventriculoatrial shunts: a single-center experience. Surg Neurol Int 2013. Ab; Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589837/
• 22 Yu S, Bensard DD, Partrick DA, Petty JK, Karrer FM, Hendrickson RJ. Laparoscopic guidance or revision of ventriculoperitoneal shunts in children. JSLS 2006; 10 (01) 122-125