Volume 12 Supplement 1
Shunt revision requirements after posthemorrhagic hydrocephalus of prematurity: insight into the time course of shunt dependency
© Ahn et al. 2015
Published: 18 September 2015
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.
We analyzed retrospectively collected data for 89 preterm patients diagnosed with Grade III and IV IVH and PHH at our institution from 1998 to 2011.
69 out of 89 patients (77.5%) underwent 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 are 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 three years following initial VP shunt insertion compared after three years, with 28 revisions versus 10 (p<0.004). In the 10 patients who underwent shunt revisions after three years, evidence of obstructive hydrocephalus was found on imaging either in the form of an isolated fourth ventricular cyst or aqueductal stenosis.
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.
- Pindrik J, Huisman TA, Mahesh M, Tekes A, Ahn ES: Analysis of limited-sequence head computed tomography for children with shunted hydrocephalus: potential to reduce diagnostic radiation exposure. J Neurosurg Pediatr. 2013, 12 (5): 491-500. 10.3171/2013.8.PEDS1322.View ArticlePubMedGoogle Scholar
- Bosemani T, Felling RJ, Wyse E, Pearl MS, Tekes A, Ahn E, Poretti A, Huisman TA: Neuroimaging findings in children with Keutel syndrome. Pediatr Radiol. 2014, 44 (1): 73-8. 10.1007/s00247-013-2768-0.View ArticlePubMedGoogle Scholar
- Seeburg D, Ahn E, Huisman T: Secondary Pediatric Encephalocele after Ventriculosubgaleal Shunting for Posthemorrhagic Hydrocephalus. Neuropediatrics. 2013 Dec 19. [Epub ahead of print]Google Scholar
- Dorafshar A, Fisher M, Borsuk D, Fishman E, Ahn E: A novel application of computer-aided design and manufacturing for reduction cranioplasty. J Craniofac Surg. 2014, 25 (1): 172-6. 10.1097/SCS.0000000000000385.View ArticlePubMedGoogle Scholar
- Aarabi B, Tofighi B, Kufera JA, Hadley J, Ahn ES, Cooper C, Malik JM, Naff NJ, Chang L, Radley M, Kheder A, Uscinski RH: Predictors of outcome in civilian gunshot wounds to the head. J Neurosurg. 2014, 120 (5): 1138-46. 10.3171/2014.1.JNS131869.View ArticlePubMedGoogle Scholar
- Bydon M, Macki M, Xu R, Ain MC, Ahn ES, Jallo GI: Spinal Decompression in Achondroplastic Patients Using High-Speed Drill Versus Ultrasonic Bone Curette: Technical Note and Outcomes in 30 Cases. J Pediatr Orthop. 2014 May 19, [Epub ahead of print]Google Scholar
- Pindrik J, Ye X, Ji BG, Pendleton C, Ahn ES: Anterior fontanelle closure and size in full-term children based on head computed tomography. Clin Pediatr (Phila). 2014, 53 (12): 1149-57. 10.1177/0009922814538492.View ArticleGoogle Scholar
- Wang JY, Amin AG, Jallo GI, Ahn ES: Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate. J Neurosurg Pediatr. 2014, 1-8.Google Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.