Journal article
Risk factors for unchanged ventricles during pediatric shunt malfunction
Journal of neurosurgery. Pediatrics, Vol.28(6), pp.703-709
12/01/2021
DOI: 10.3171/2021.6.PEDS2125
PMID: 34560626
Abstract
OBJECTIVE Children whose ventricles do not change during shunt malfunction present a diagnostic dilemma. This study was performed to identify risk factors for unchanged ventricular size at shunt malfunction.
METHODS This retrospective 1:1 age-matched case-control study identified children with shunted hydrocephalus who underwent shunt revision with intraoperative evidence of malfunction at one of the three participating institutions from 1997 to 2019. Cases were defined as patients with a change of < 0.05 in the frontal-occipital horn ratio (FOR) between malfunction and baseline, and controls included patients with FOR changes >= 0.05. The presence of infection, abdominal pseudocyst, pseudomeningocele, or wound drainage and lack of baseline cranial imaging at the time of malfunction warranted exclusion.
RESULTS Of 450 included patients, 60% were male, 73% were Caucasian, and 67% had an occipital shunt. The median age was 4.3 (IQR 0.97-9.21) years at malfunction. On univariable analysis, unchanged ventricles at malfunction were associated with a frontal shunt (41% vs 28%, p < 0.001), programmable valve (17% vs 9%, p = 0.011), nonsiphoning shunt (85% vs 66%, p < 0.001), larger baseline FOR (0.44 +/- 0.12 vs 0.38 +/- 0.11, p < 0.001), no prior shunt infection (87% vs 76%, p = 0.003), and no prior shunt revisions (68% vs 52%, p < 0.001). On multivariable analysis with collinear variables removed, patients with a frontal shunt (OR 1.67, 95% CI 1.08-2.70, p = 0.037), programmable valve (OR 2.63, 95% CI 1.32-5.26, p = 0.007), nonsiphoning shunt at malfunction (OR 2.76, 95% CI 1.63-4.67, p < 0.001), larger baseline FOR (OR 3.13, 95% CI 2.21-4.43, p < 0.001), and no prior shunt infection (OR 2.34, 95% CI 1.27-4.30, p = 0.007) were more likely to have unchanged ventricles at malfunction.
CONCLUSIONS In a multicenter cohort of children with shunt malfunction, those with a frontal shunt, programmable valve, nonsiphoning shunt, baseline large ventricles, and no prior shunt infection were more likely than others to have unchanged ventricles at shunt failure.
Details
- Title: Subtitle
- Risk factors for unchanged ventricles during pediatric shunt malfunction
- Creators
- Rebecca A. Reynolds - Vanderbilt University Medical CenterRanbir Ahluwalia - Monroe Carell Jr. Children's HospitalVishal Krishnan - University of Colorado DenverKatherine A. Kelly - Vanderbilt UniversityJaclyn Lee - Vanderbilt UniversityRaymond P. Waldrop - University of Alabama at BirminghamBradley Guidry - Vanderbilt UniversityAstrid C. Hengartner - University of Colorado DenverJustin McCroskey - University of Alabama at BirminghamAnastasia Arynchyna - University of Alabama at BirminghamSusan Staulcup - Children's Hospital ColoradoHeidi Chen - Monroe Carell Jr. Children's HospitalTodd C. Hankinson - Children's Hospital ColoradoBrandon G. Rocque - University of Alabama at BirminghamChevis N. Shannon - Vanderbilt University Medical CenterRobert Naftel - Vanderbilt University Medical Center
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery. Pediatrics, Vol.28(6), pp.703-709
- Publisher
- Amer Assoc Neurological Surgeons
- DOI
- 10.3171/2021.6.PEDS2125
- PMID
- 34560626
- ISSN
- 1933-0707
- eISSN
- 1933-0715
- Number of pages
- 7
- Language
- English
- Date published
- 12/01/2021
- Academic Unit
- Neurosurgery
- Record Identifier
- 9984446407302771
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