Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Childs Nerv Syst. 2023 Aug;39(8):2105-2113. doi: 10.1007/s00381-023-05928-x. Epub 2023 Apr 14.
The aim of this study is to analyze rates of ventriculopleural (VPL) shunt failure and complications among patients with pediatric hydrocephalus, and to analyze which factors may predict early (< 1 year) or late (> 1 year) VPL shunt failure in this sample.
A retrospective chart review was conducted of all consecutive VPL shunt placements from 2000 to 2019 at our institution. Data was collected on patient characteristics, shunt history, and shunt type. Primary endpoints include rates of VPL shunt survival and rates of symptomatic pleural effusion. The Kaplan-Meier method was used to calculate shunt survival, and Fisher's exact test and t-test were used to compare differences between categorical variables and means, respectively (p < 0.05).
Thirty-one patients with pediatric hydrocephalus underwent VPL shunt placement (mean age 14.2 years). Of the 27 patients with long-term follow-up (mean 46 months), VPL shunt revision was required in 19, seven of which were due to pleural effusion. Overall shunt survival rates at 1, 3, 5, and 7 years were 76%, 62%, 55%, and 46%, respectively. Mean duration of shunt survival was 26.74 months. Overall pleural effusion rate was 26%. No patient-specific factors, including shunt valve type, were significantly associated with shunt survival, risk of early revision, or risk of pleural effusion.
Our results are comparable to those reported in the literature and represent one of the largest case series on the topic. VPL shunts are a viable second-line option when ventriculoperitoneal (VP) shunt placement is not possible or desirable, though there are high rates of shunt revision and pleural effusion.
本研究旨在分析小儿脑积水患者脑室胸膜（VPL）分流失败和并发症的发生率，并分析哪些因素可能预测本样本中早期（<1 年）或晚期（>1 年）VPL 分流失败。
对我院 2000 年至 2019 年所有连续 VPL 分流术的病历进行回顾性图表分析。收集患者特征、分流史和分流类型的数据。主要终点包括 VPL 分流生存率和症状性胸腔积液发生率。使用 Kaplan-Meier 法计算分流生存情况，Fisher 确切检验和 t 检验分别用于比较分类变量和均值之间的差异（p<0.05）。
31 例小儿脑积水患者行 VPL 分流术（平均年龄 14.2 岁）。27 例长期随访（平均 46 个月）患者中，19 例需要进行 VPL 分流术修订，其中 7 例因胸腔积液。1、3、5 和 7 年的总体分流生存率分别为 76%、62%、55%和 46%。平均分流生存时间为 26.74 个月。总体胸腔积液发生率为 26%。没有患者特定的因素，包括分流阀类型，与分流生存、早期修订风险或胸腔积液风险显著相关。
我们的结果与文献报道的结果相当，代表了该主题最大的病例系列之一。当脑室腹膜（VP）分流术不可行或不希望进行时，VPL 分流术是一种可行的二线选择，尽管存在较高的分流术修订和胸腔积液发生率。
