Dupepe Esther B, Hopson Betsy, Johnston James M, Rozzelle Curtis J, Jerry Oakes W, Blount Jeffrey P, Rocque Brandon G
Department of Neurosurgery, and.
Section of Pediatric Neurosurgery, Children's Hospital of Alabama and the University of Alabama at Birmingham, Alabama.
Neurosurg Focus. 2016 Nov;41(5):E6. doi: 10.3171/2016.8.FOCUS16257.
OBJECTIVE It is generally accepted that cerebrospinal fluid shunts fail most frequently in the first years of life. The purpose of this study was to describe the risk of shunt failure for a given patient age in a well-defined cohort with shunted hydrocephalus due to myelomeningocele (MMC). METHODS The authors analyzed data from their institutional spina bifida research database including all patients with MMC and shunted hydrocephalus. For the entire population, the number of shunt revisions in each year of life was determined. Then the number of patients at risk for shunt revision during each year of life was calculated, thus enabling them to calculate the rate of shunt revision per patient in each year of life. In this way, the timing of all shunt revision operations for the entire clinic population and the likelihood of having a shunt revision during each year of life were calculated. RESULTS A total of 655 patients were enrolled in the spina bifida research database, 519 of whom had a diagnosis of MMC and whose mean age was 17.48 ± 11.7 years (median 16 years, range 0-63 years). Four hundred seventeen patients had had a CSF shunt for the treatment of hydrocephalus and thus are included in this analysis. There were 94 shunt revisions in the 1st year of life, which represents a rate of 0.23 revisions per patient in that year. The rate of shunt revision per patient-year initially decreased as age increased, except for an increase in revision frequency in the early teen years. Shunt revisions continued to occur as late as 43 years of age. CONCLUSIONS These data substantiate the idea that shunt revision surgeries in patients with MMC are most common in the 1st year of life and decrease thereafter, except for an increase in the early teen years. A persistent risk of shunt failure was observed well into adult life. These findings underscore the importance of routine follow-up of all MMC patients with shunted hydrocephalus and will aid in counseling patients and families.
目的 人们普遍认为，脑脊液分流术在生命的最初几年最常失败。本研究的目的是描述在一个明确界定的因脊髓脊膜膨出（MMC）导致脑积水且接受分流术的队列中，特定患者年龄的分流失败风险。方法 作者分析了其机构脊柱裂研究数据库中的数据，包括所有患有MMC和脑积水并接受分流术的患者。对于整个人群，确定了生命各年的分流术修订次数。然后计算每年有分流术修订风险的患者数量，从而能够计算出生命各年每位患者的分流术修订率。通过这种方式，计算了整个临床人群所有分流术修订手术的时间以及生命各年进行分流术修订的可能性。结果 共有655名患者纳入脊柱裂研究数据库，其中519名诊断为MMC，平均年龄为17.48±11.7岁（中位数16岁，范围0 - 63岁）。417名患者因脑积水接受了脑脊液分流术，因此纳入本分析。生命第1年有94次分流术修订，即该年每位患者的修订率为0.23次。除青少年早期修订频率增加外，每位患者每年的分流术修订率最初随年龄增长而下降。分流术修订甚至在43岁时仍有发生。结论 这些数据证实了以下观点：MMC患者的分流术修订手术在生命第1年最常见，此后减少，但青少年早期有所增加。在成年期仍观察到持续的分流失败风险。这些发现强调了对所有接受分流术的MMC脑积水患者进行常规随访的重要性，并将有助于为患者及其家属提供咨询。
