Lee Lester, Low Sharon, Low David, Ng Lee Ping, Nolan Colum, Seow Wan Tew
Neurosurgical Service, KKH Women's and Children's Hospital.
Department of Neurosurgery, National Neuroscience Institute (Singapore); and.
Neurosurg Focus. 2016 Nov;41(5):E7. doi: 10.3171/2016.8.FOCUS16277.
OBJECTIVE The introduction of ventriculoperitoneal shunts changed the way hydrocephalus was treated. Whereas much is known about the causes of shunt failure in the first few years, there is a paucity of data in the literature regarding the cause of late shunt failures. The authors conducted a study to find out the different causes of late shunt failures in their institution. METHODS A 10-year retrospective study of all the patients who were treated in the authors' hospital between 2006 and 2015 was conducted. Late shunt failures included those in patients who had to undergo shunt revision more than 5 years after their initial shunt insertion. The patient's notes and scans were reviewed to obtain the age and sex of the patient, the time it took for the shunt to fail, the reason for failure, and the patient's follow-up. RESULTS Forty-six patients in the authors' institution experienced 48 late shunt failures in the last 10 years. Their ages ranged from 7 to 26 years (12.23 ± 4.459 years [mean ± SD]). The time it took for the shunts to fail was between 6 and 24 years (mean 10.25 ± 3.77 years). Reasons for failure resulting in shunt revision include shunt fracture in 24 patients (50%), shunt blockage in 14 patients (29.2%), tract fibrosis in 6 patients (12.5%), shunt dislodgement in 2 patients (4.2%), and shunt erosion in 2 patients (4.2%). Postoperative follow-up for the patients ranged from 6 to 138 months (mean 45.15 ± 33.26 months). CONCLUSIONS Late shunt failure is caused by the effects of aging on the shunt, and the complications are different from early shunt failure. A large proportion are complications associated with shunt calcification. The authors advocate a long follow-up for pediatric patients with shunts in situ to monitor them for various causes of late shunt failure.
目的 脑室腹腔分流术的引入改变了脑积水的治疗方式。虽然人们对最初几年分流失败的原因了解很多，但文献中关于晚期分流失败原因的数据却很少。作者开展了一项研究，以找出其所在机构晚期分流失败的不同原因。方法 对2006年至2015年期间在作者所在医院接受治疗的所有患者进行了一项为期10年的回顾性研究。晚期分流失败包括那些在初次分流术后5年以上不得不接受分流修正术的患者。查阅患者病历和扫描结果，以获取患者的年龄和性别、分流失败的时间、失败原因以及患者的随访情况。结果 在过去10年中，作者所在机构的46例患者出现了48次晚期分流失败。他们的年龄在7岁至26岁之间（平均12.23±4.459岁[均值±标准差]）。分流失败的时间在6年至24年之间（平均10.25±3.77年）。导致分流修正术的失败原因包括24例（50%）分流管断裂、14例（29.2%）分流管堵塞、6例（12.5%）通道纤维化、2例（4.2%）分流管移位和2例（4.2%）分流管侵蚀。患者的术后随访时间为6个月至138个月（平均45.15±33.26个月）。结论 晚期分流失败是由衰老对分流管的影响所致，其并发症与早期分流失败不同。很大一部分是与分流管钙化相关的并发症。作者主张对原位分流的儿科患者进行长期随访，以监测晚期分流失败的各种原因。
