Alojan Abdulrazaq A, Alotaibi Assayl R, Alalhareth Hussain N, Alwadei Ali D, Ammar Ahmed
Department of Neurosurgery, Pediatric Neurosurgery Unit, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Saudi J Med Med Sci. 2021 Sep-Dec;9(3):261-266. doi: 10.4103/sjmms.sjmms_85_21. Epub 2021 Aug 31.
Infection following ventriculoperitoneal shunt (VPS) placement is a recognized complication, with variable incidence rates worldwide. Development of post-infectious multiloculated hydrocephalus (MLH) is likely if VPS infection is improperly managed, in turn affecting the prognosis. There is a lack of studies from Saudi Arabia regarding patients' functional outcome in relation to different variables.
To study the causative organisms, related variables and patient outcomes in MLH after VPS infection.
This case series is a retrospective chart review of pediatric patients diagnosed with hydrocephalus from 2011 to 2019. Patients were included if they were aged <18 years, had confirmed cerebrospinal fluid/blood infection with radiological evidence of MLH, and were regularly followed-up. Functional status score was used to evaluate the outcomes.
A total of 150 patients underwent VPS insertion during the study period, of which 12 (8%) had postinfection MLH. The mean age at diagnosis and follow-up was 9 and 19 months, respectively. Ten patients developed MLH after their first VPS infection and one each developed MLH following the second and third VPS infections. Cerebrospinal fluid cultures mostly grew only single organisms (6/12), with species being the most common. All patients underwent navigated endoscopic fenestration; nine patients required VPS placement and three required redo endoscopic fenestration surgery. All patients were developmentally delayed, with the majority (75%) having a functional status score of 6-10.
Development of MLH after VPS infection is debilitating and requires prompt treatment. Although the overall functional outcome is poor, evolving neuroendoscopic techniques with tailored preoperative planning may play a role in reducing the adverse effect of shunt multiplicity, shunt infections and the higher failure rate among patients with complex hydrocephalus.
脑室腹腔分流术（VPS）置入后感染是一种公认的并发症，在全球范围内发病率各不相同。如果VPS感染处理不当，可能会发展为感染后多房性脑积水（MLH），进而影响预后。沙特阿拉伯缺乏关于不同变量与患者功能结局关系的研究。
研究VPS感染后MLH的致病微生物、相关变量及患者结局。
本病例系列是对2011年至2019年诊断为脑积水的儿科患者进行的回顾性病历审查。纳入标准为年龄小于18岁、脑脊液/血液感染确诊且有MLH影像学证据并接受定期随访的患者。采用功能状态评分评估结局。
在研究期间，共有150例患者接受了VPS置入，其中12例（8%）发生了感染后MLH。诊断和随访时的平均年龄分别为9个月和19个月。10例患者在首次VPS感染后发生MLH，1例在第二次VPS感染后发生MLH，1例在第三次VPS感染后发生MLH。脑脊液培养大多仅培养出单一微生物（6/12），其中[具体菌种]最为常见。所有患者均接受了导航内镜开窗术；9例患者需要再次置入VPS，3例需要再次进行内镜开窗手术。所有患者均有发育迟缓，大多数（75%）功能状态评分为6 - 10分。
VPS感染后发生MLH会导致功能衰弱，需要及时治疗。尽管总体功能结局较差，但不断发展的神经内镜技术及量身定制的术前规划可能有助于减少分流复杂性、分流感染及复杂脑积水患者较高失败率的不良影响。
