Department of Radiology, St. Louis University School of Medicine, St. Louis, MO, USA.
Department of Neurosurgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA.
Pediatr Radiol. 2019 Dec;49(13):1773-1780. doi: 10.1007/s00247-019-04488-0. Epub 2019 Aug 16.
Calcifications along ventricular catheters have been associated with shunt fractures although it is unknown whether their development predicts whether and when the shunts will fracture.
To determine whether extracranial calcifications found on a radiographic shunt series predicts whether a patient will experience a shunt catheter fracture or complication.
A retrospective review was performed of pediatric patients with a ventricular shunt placed before 18 years of age and radiographic shunt series. Two thousand, six hundred and thirty shunt series in 523 patients (301 male) were reviewed to identify the development of calcifications around the catheter and fracture. Fifty-one patients were excluded for preexisting calcifications with shunt fracture. (48) Absence of shunt (2) or age (1). Analysis included descriptive statistics, odds ratio and chi-square test results.
Four hundred seventy-two patients were included. Of the 59 shunts in 58 patients that developed calcifications, 23 went on to fracture (39%). Forty shunts without calcification in 37 patients developed fractures. There is a significant positive association between calcification and fracture (Χ=39.1, P<0.01). It is 6.12 times more likely that a fractured shunt had calcifications compared to a non-fractured shunt having calcifications. Calcifications appeared within an average of 9 years, 10 months (range: 4-14 years) after shunt insertion. Shunt fractures occurred within an average of 5 years, 2 months (range: 6 months-9 years) after the appearance of calcifications with a median patient age of 14.6 years. Nearly all fractures were at or adjacent to the calcifications, most commonly in the neck (17/23; 73.9%).
Shunt calcification represents a significant risk for catheter fracture in the pediatric population. Early intervention or closer interval follow-up may be indicated in those found to have calcifications.
尽管目前尚不清楚钙化的出现是否预示着分流管何时以及是否会发生断裂，但脑室导管周围的钙化与分流管断裂有关。
确定放射学分流系列中发现的颅外钙化是否可预测患者是否会发生分流导管断裂或并发症。
对 523 例（301 例男性）年龄在 18 岁以下并接受放射学分流系列检查的患者进行了回顾性研究。共回顾了 2630 次分流系列，以确定导管周围和断裂处是否有钙化形成。51 例因分流管骨折合并预先存在的钙化而被排除（48 例无分流管、2 例无分流管、1 例年龄太小）。分析包括描述性统计、优势比和卡方检验结果。
472 例患者被纳入研究。在 58 例患者的 59 个出现钙化的分流管中，有 23 个发生了断裂（39%）。37 例无钙化的 40 个分流管发生了骨折。钙化与骨折之间存在显著的正相关关系（Χ=39.1，P<0.01）。与未发生骨折的有钙化分流管相比，发生骨折的分流管发生钙化的可能性要高出 6.12 倍。钙化平均出现在分流管置入后 9 年 10 个月（4-14 年），平均在出现钙化后 5 年 2 个月（6 个月-9 年）发生分流管断裂，中位患者年龄为 14.6 岁。几乎所有的骨折都发生在钙化处或其附近，最常见的部位是颈部（17/23；73.9%）。
在儿科人群中，分流钙化是导管断裂的一个显著危险因素。对于发现有钙化的患者，可能需要早期干预或更密切的随访间隔。
