[Clinical analysis of pediatric shunt catheter fracture].
Between 1985 and 1998, 415 shunt dysfunctions occurred at Kobe Children's Hospital. The main reasons for shunt revision were obstruction of the catheter, shunt infection, and shunt disconnection. This report presents an analysis of 35 patients (36 cases) who underwent a ventriculoperitoneal (VP) shunt revision because of shunt catheter fracture. All patients were less than 18 years old. We researched their age at the time of revision, site of disruption, postoperative period, shunt system, clinical symptoms, and other factors. The mechanical aspects of shunt catheter fracture are also discussed in this report. The peak time of shunt catheter fracture was the time when children were growing up and were entering elementary school. In other words, when their height was increasing rapidly. At that time, the distal catheter is subjected to traction between the valve and the abdomen at the site of insertion in either the upper or lower direction. However, physical examination of the shunt catheter showed normal range. Additional contributory factors were chronic stimulation at the occipital bone, clavium bone, and costal arch, while movement of the neck and body rotation also caused shunt catheter fracture. These factors all originated from shearing strain at the shunt catheter. We look forward to the introduction of a stronger shunt catheter, because surgical repair time must be minimized to protect the child's mental development. In addition, shearing strain at the shunt catheter needs special attention.
Department of Neurosurgery, Kobe Children's Hospital, Japan.
Akitsugu
A
Morishita
Tatsuya
T
Nagashima
Hiromitsu
H
Kurata
Takahiro
T
Eguchi
Norihiko
N
Tamaki
D000367:Age Factors; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D013314:Stress, Mechanical; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*