VENTRICULAR SHUNT SURVIVAL IN CHILDREN WITH NEURAL TUBE DEFECTS

Abstract

Although ventricular shunting has revolutionized care of children with hydrocephalus, problems with shunts are extremely common. Shunt malfunctions can cause serious morbidity and accounted for 1% of admissions to SMH in 1982. Children thus admitted average 9 days in hospital (mean cost, $4,543). To document shunt problems in children with hydrocephalus, 66 children born since 1973 who had neural tube defect and shunted hydrocephalus were studied via life-table analysis. 45% required revision (mean no. of revisions, 1.5; range, 1-5). 30% of the shunts failed within 9 mos. after insertion; 50% failed within 4 yrs. Shunts inserted in the 1st yr. of life were much more likely to fail than those inserted after 1 yr. of age (p<.05). Children with 1 or more shunt failures were not more likely to have subsequent failures. Similarly, the type of shunt (ventriculo-peritoneal, ventriculo-atrial), brand of shunt (Hakim, Pudenz, other), and shunt pressure (low, medium) were not correlated with the risk of failure. The interval between closure of the lesion and shunt insertion, and head circumference percentile at time of insertion were also not correlated with shunt failure. 48% of children requiring revision had symptoms of increased intracranial pressure; 14% had bacterial shunt infections. 74% of the revisions required head surgery. Thus, although ventricular shunts have resulted in dramatic improvement in care of children with hydrocephalus, major improvement in such shunts are needed to decrease morbidity caused by their frequent failures.