Characteristics of ventricular shunt malfunctions among patients with neurocysticercosis.
OBJECTIVE
Ventricular shunts used to relieve hydrocephalus among patients with neurocysticercosis have been plagued by high shunt malfunction rates. We examined the characteristics of shunt malfunctions among patients with neurocysticercosis.


METHODS
This is a retrospective chart review of data for 122 patients who were admitted with a diagnosis of cysticercosis during a 5.5-year period. Cases of hydrocephalus requiring shunt placement were reviewed with respect to the segment of shunt obstruction, disease activity at the time of shunt placement, and the effects of antihelminthic treatment on shunt failures and longevity.


RESULTS
Twenty-one patients required 49 operations for relief of hydrocephalus, including 22 new shunt placements, 23 revisions, and 4 cyst extirpations. Of these shunt failures, 78% occurred within the first 12 months and 96% within 3 years. Of the failures that occurred in the distal segment, 75% occurred within 6 months. By comparison, 33% of proximal segment obstructions and 50% of the total number of valve obstructions occurred within the first 6 months. Of the shunts placed during the vesicular stage of infection, 63% required revisions, compared with 29% of those placed during the colloidal through calcified stages. Nineteen shunts were placed during the vesicular stage, and nine patients received a full course of antihelminthic treatment after shunt placement. In less than 6 months, 33% of the cases involving shunt placement followed by antihelminthic treatment exhibited shunt failure, compared with 90% of the cases without antihelminthic treatment (P < 0.05, chi(2) test).


CONCLUSIONS
Among patients with vesicular stage cysticercosis, placement of a ventriculoperitoneal shunt followed by a course of antihelminthic medication seems to promote shunt longevity.
Kelley
Rosemarie
R
Department of Neuroscience, Kenneth Hahn Comprehensive Stroke and Epilepsy Center, Martin Luther King, Jr./Charles R. Drew Medical Center, Los Angeles, California 90059, USA.
Duong
Duc H
DH
Locke
George E
GE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000871:Anthelmintics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D020019:Neurocysticercosis / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
D000871:Anthelmintics