title: Shunt revision requirements after posthemorrhagic hydrocephalus of prematurity: insight into the time course of shunt dependency.
abstract: OBJECTIVE
  Intraventricular hemorrhage (IVH) is a common affliction of preterm infants and often results in posthemorrhagic hydrocephalus (PHH). These patients typically eventually require permanent CSF diversion and are presumed to be indefinitely shunt-dependent. To date, however, there has been no study of long-term shunt revision requirements in patients with PHH.
  
  
  METHODS
  We analyzed retrospectively collected data for 89 preterm patients diagnosed with grades III and IV IVH and PHH at our institution from 1998 to 2011.
  
  
  RESULTS
  Sixty-nine out of 89 patients (77.5%) underwent ventriculoperitoneal (VP) shunt placement, and 33 (47.8%) required at least one shunt revision and 18 (26.1%) required multiple revisions. The mean ± standard deviation follow-up time for shunted patients was 5.0 ± 3.3 years. The majority of early failures were due to proximal catheter malfunction, while later failures were mostly due to distal catheter problems. There was a significant difference in the number of patients requiring revisions in the first 3 years following initial VP shunt insertion compared after 3 years, with 28 revisions versus 10 (p < 0.004). In 8 out of 10 patients who underwent shunt revisions after 3 years, evidence of obstructive hydrocephalus was found on imaging either in the form of an isolated fourth ventricular cyst or aqueductal stenosis.
  
  
  CONCLUSIONS
  Our results suggest that in a distinct subset of patients with PHH, obstructive hydrocephalus may develop, resulting in long-term dependence on CSF diversion. Further study on the factors associated with long-term shunt dependence and revision requirements within the PHH group is warranted.
authors.affiliation: Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 560A, Baltimore, MD, 21287, USA.
authors.forename: Joanna Y
authors.initials: JY
authors.lastname: Wang
authors.affiliation: Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 560A, Baltimore, MD, 21287, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Jackson
authors.affiliation: Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 560A, Baltimore, MD, 21287, USA.
authors.forename: George I
authors.initials: GI
authors.lastname: Jallo
authors.affiliation: Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 560A, Baltimore, MD, 21287, USA. eahn4@jhmi.edu.
authors.forename: Edward S
authors.initials: ES
authors.lastname: Ahn
mesh_terms: D002543:Cerebral Hemorrhage / Q000601:surgery*; D002552:Cerebral Ventricles / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D015898:Tomography Scanners, X-Ray Computed; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000379:methods*
keywords: Hydrocephalus; Intraventricular hemorrhage; Posthemorrhagic hydrocephalus; Revision; Shunt