title: Time dependent pattern of cellular characteristics causing ventriculoperitoneal shunt failure in children.
abstract: BACKGROUND
  Ventriculoperitoneal shunt obstruction remains a major problem in pediatric neurosurgery. We analyzed the tissue reaction to ventriculoperitoneal shunts and compared the histology versus time elapsed to shunt failure.
  
  
  METHODS
  85 ventricular catheter tissues samples obtained from 71 patients were reviewed along with time elapsed to shunt revision. Pathology reports of all tissue samples were divided into three categories: inflammatory based on the presence of lymphocytes, macrophages, and microglial cells; reactive based on the presence of fibro-connective tissue, reactive astrocytes, and Rosenthal fibers; and normal brain tissue based on presence of choroid plexus. These categories were then grouped according to time elapsed to shunt revision. Group I had those shunts revised <6 months, group II included shunts revised between 6 months and 3 years, while group III had shunts revised after more than 3 years.
  
  
  RESULTS
  The incidence of inflammatory type of histology was 44% (16/36) in group I, 22% (6/27) in group II, and 18% (4/22) in group III. The reactive histology was 42% (15/36) in group I, 67% (18/27) in group II, and 77% (17/22) in group III. There was a clear noted difference of incidence between inflammatory versus reactive histology between early shunt failure compared to late shunt failure. Incidence of normal brain tissue remained high in group I with 8%, 11% in group II, and none in group III.
  
  
  CONCLUSIONS
  Early shunt obstruction arises from pathologies different from those causing late shunt obstructions.
authors.affiliation: Icahn School of Medicine, Department of Neurosurgery, Mount Sinai Medical Center, New York, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Sarkiss
authors.affiliation: David Geffen School of Medicine at UCLA, Department of Neurosurgery, Los Angeles, USA.
authors.forename: Rajashree
authors.initials: R
authors.lastname: Sarkar
authors.affiliation: David Geffen School of Medicine at UCLA, Division of Neuropathology, Los Angeles, USA.
authors.forename: William
authors.initials: W
authors.lastname: Yong
authors.affiliation: David Geffen School of Medicine at UCLA, Department of Neurosurgery, Los Angeles, USA. Electronic address: jlazareff@mednet.ucla.edu.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Lazareff
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology*; D057785:Catheters; D002648:Child; D002675:Child, Preschool; D002831:Choroid Plexus / Q000473:pathology; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007249:Inflammation / Q000473:pathology; D008297:Male; D019635:Neurosurgical Procedures; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*; D055815:Young Adult
keywords: Neuropathology; Pediatric neurosurgery; Ventriculoperitoneal shunt failure; Ventriculoperitoneal shunt obstruction