Outcome of ventriculoperitoneal shunt and predictors of shunt revision in infants with posthemorrhagic hydrocephalus.
OBJECTIVE
Ventriculoperitoneal (VP) shunts in infants with posthemorrhagic hydrocephalus (PHH) are prone to failures, with some patients at risk for multiple revisions. The objective of our study is to observe long-term outcomes and identify factors leading to proximal and distal multiple failures.


METHODS
We performed a retrospective review of infants with PHH that required VP shunt placement between 1982 and 2014. These patients were monitored clinically and radiographically after VP shunt placement.


RESULTS
A total of 502 surgical procedures (initial shunt insertion and revisions) were performed, with 380 shunt revisions in 102 (84 %) patients. Median shunt survival time was 54 months (0.03-220 months). Shunt survival was significantly affected by the following factors: intraventricular hemorrhage (IVH, grade II-III, 95 months vs. grade IV, 28 months, p = 0.022), birth weight (<1.5 kg, 59 months vs. >1.5 kg, 22 months, p = 0.005), gestational age (>27 weeks, 90 months vs. <27 weeks, 20 months, p < 0.0001), distal vs. proximal revision (133 months vs. 48 months, p = 0.013), obstruction (yes, 78 months vs. no, 28 months, p = 0.007), and infection (no, 75 months vs. yes, 39 months, p = 0.045). Regression analysis revealed that multiple gestation, head circumference (>27 cm), congenital anomalies, infection, and obstruction increased the proximal and distal shunt malfunction.


CONCLUSIONS
Long-term outcome of VP shunt placement in infants revealed a relatively high rate of complications requiring shunt revision as late as 30 years after initial placement. Infants with VP shunts should be monitored lifelong of these patients by neurosurgeons.
Department of Neurosurgery, LSU Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130-3932, USA.
Shyamal C
SC
Bir
Department of Neurosurgery, LSU Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130-3932, USA.
Subhas
S
Konar
Department of Neurosurgery, LSU Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130-3932, USA.
Tanmoy Kumar
TK
Maiti
Department of Neurosurgery, LSU Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130-3932, USA.
Piyush
P
Kalakoti
Department of Neurosurgery, LSU Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130-3932, USA.
Papireddy
P
Bollam
Department of Neurosurgery, LSU Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130-3932, USA. ananda@lsuhsc.edu.
Anil
A
Nanda
D001724:Birth Weight; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D007223:Infant; D007235:Infant, Premature, Diseases; D008297:Male; D059906:Neuroimaging; D012044:Regression Analysis; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*
Hydrocephalus; Intraventricular hemorrhage; Revision; Shunt