Arfaie Saman, Sarabi Ali, Solgi Arad, Michaud Eve, Rohr Eliana, Giampa Luca, Ieropoli Elyssia, Lasry Oliver, Dudley Roy W R
1Division of Neurosurgery, Department of Pediatric Surgery, McGill University, Montréal, Québec, Canada.
2Division of Neurosurgery, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
J Neurosurg Pediatr. 2024 Nov 15;35(2):158-166. doi: 10.3171/2024.8.PEDS23548. Print 2025 Feb 1.
Cerebral spinal fluid (CSF) diversion methods, including ventriculoperitoneal (VP) shunts, are the standard treatment for hydrocephalus. Hair clipping (HC) has been a routine neurosurgical practice of the great majority of neurosurgeons, due to the perception that this will either decrease the risk of shunt infection or allow for a faster, unimpeded opening and closing of the skin. The benefits of not cutting or clipping hair in terms of normalizing appearance and self-esteem are obvious. The purpose of this study was to assess whether the rate of shunt infection would differ between pediatric patients receiving operation via the hair-sparing (HS) approach versus HC.
A retrospective single-institution study comparing HS versus HC was conducted on pediatric patients undergoing long-term CSF shunt procedures at the Montreal Children's Hospital between August 2014 and April 2021. The primary outcome measure was shunt infection at 90 days and at long-term follow-up. Inclusion criteria were having at least 18 months of follow-up after long-term CSF shunt procedures, including insertions or revisions of VP shunts, ventriculoatrial shunts, cystoperitoneal shunts, subdural-peritoneal shunts, ventriculosubgaleal shunts, and ventriculosubgaleal reservoirs. Excluded procedures were those involving external ventricular drains, externalized shunts, Omaya reservoirs, endoscopic third ventriculostomies, and lumbar shunts.
There were 434 CSF shunt procedures performed in 226 unique patients; 155 (35.71%) procedures were done using the HS approach versus 279 (64.29%) procedures via HC. At 90 days postoperatively, the infection rate was 1.29% in the HS group and 2.87% in the HC group, with an absolute risk difference of 1.58% (95% CI -1.07% to 4.23%, p = 0.24). At long-term follow-up (mean follow-up: 752 days and 716 days for the HS and HC groups, respectively), the rate of shunt infection remained at 1.29% for the HS group (no new infections) but rose to 4.66% for the HC group, with an absolute risk difference of 3.37% (95% CI 0.33%-6.41%, p = 0.03).
Performing CSF shunt procedures without cutting or clipping any hair has a very low risk of shunt infection, and certainly does not appear to increase the risk of infection (or malfunction) versus the hair removal approach. It is a safe alternative and should be considered due to its esthetic and psychological benefits regarding normalization of appearance and ease of resuming a normal life following shunt surgery.
脑脊液（CSF）分流方法，包括脑室腹腔（VP）分流术，是脑积水的标准治疗方法。由于大多数神经外科医生认为剪发（HC）要么会降低分流感染的风险，要么能使皮肤切口更快、更顺畅地打开和闭合，因此剪发一直是绝大多数神经外科医生的常规手术操作。不剪发在恢复外观和自尊方面的益处显而易见。本研究的目的是评估接受保留头发（HS）手术方法与剪发手术的儿科患者之间的分流感染率是否存在差异。
对2014年8月至2021年4月在蒙特利尔儿童医院接受长期CSF分流手术的儿科患者进行了一项回顾性单机构研究，比较HS与HC。主要结局指标是术后90天及长期随访时的分流感染情况。纳入标准为长期CSF分流手术后至少有18个月的随访，包括VP分流术、脑室心房分流术、囊肿腹腔分流术、硬膜下腹腔分流术、脑室帽状腱膜下分流术和脑室帽状腱膜下贮液器的置入或翻修。排除的手术包括涉及外部脑室引流管、外置分流管、奥马亚贮液器、内镜下第三脑室造瘘术和腰部分流术。
226例独特患者共进行了434例CSF分流手术；155例（35.71%）手术采用HS方法，279例（64.29%）手术采用HC方法。术后90天，HS组感染率为1.29%，HC组为2.87%，绝对风险差异为1.58%（95%CI -1.07%至4.23%，p = 0.24）。在长期随访中（HS组和HC组的平均随访时间分别为752天和716天），HS组的分流感染率保持在1.29%（无新感染），而HC组上升至4.66%，绝对风险差异为3.37%（95%CI 0.33%-6.41%，p = 0.03）。
不剪发进行CSF分流手术的分流感染风险非常低，与剪发方法相比，肯定不会增加感染（或故障）风险。这是一种安全的替代方法，鉴于其在恢复外观和分流手术后轻松恢复正常生活方面的美学和心理益处，应予以考虑。
