What should we do with a discontinued shunt?
OBJECTIVE
The reported rate is up to 10% of shunt disconnection or fracture, either ventriculoperitoneal or subduroperitoneal. However, not all of shunt discontinuity is associated with shunt malfunction. We analyzed the discontinuity of the shunt system and related factors and tried to present a follow-up policy.


METHODS
This is a retrospective study involving 22 patients who presented with shunt disconnection because of malfunction or other reasons between January 2003 and October 2008. To evaluate shunt function, we performed a shuntogram, temporary ligation, or intraoperative exploration.


RESULTS
Nine (40.9%) of 22 patients had nonfunctioning shunts. The shunt system was removed in eight cases, and one patient refused surgical management. Of these 22 patients with disconnected shunts, 17 shunts placed in the occipital area were discontinued. The discontinuations were mostly fractured at neck (52%), not disconnected at connection site.


CONCLUSIONS
Shunt disconnection has not been always represented a shunt malfunction. We thought many patients with disconnected shunt may be independent from shunt system, and it can be a good chance for patient to remove the shunt system.
Lee
Yun-Ho
YH
Pediatric Neurosurgery, Severance Children's Hospital, Department of Neurosurgery, Brain Korea 21 Project for Medical Science, College of Medicine, Yonsei University, 134 Shinchon-Dong, Seodaemoon-Gu, 120-752, Seoul, South Korea.
Park
Eun Kyung
EK
Kim
Dong-Seok
DS
Choi
Joong-Uhn
JU
Shim
Kyu-Won
KW
D000293:Adolescent; D000328:Adult; D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors; D017287:Ventriculoperitoneal Shunt / Q000295:instrumentation*; D055815:Young Adult