Children whose ventricles do not change due to shunt failure pose a diagnostic challenge. For this study, researchers wanted to find risk variables for unaltered ventricular size when a shunt fails. From 1997 to 2019, children with shunted hydrocephalus who had shunt revision with intraoperative signs of malfunction at one of the three participating institutions were identified in this retrospective 1:1 age-matched case-control research. Patients with a frontal–occipital horn ratio (FOR) change of 0.05 between malfunction and baseline were considered cases, while patients with FOR changes of 0.05 were considered controls. Infection, abdominal pseudocyst, pseudomeningocele, or wound drainage were all ruled out, as was the lack of baseline cranial imaging at the time of the malfunction.
About 60% of the 450 patients included in the study were men, 73% were Caucasians, and 67% had an occipital shunt. At the time of the malfunction, the median age was 4.3 years (IQR 0.97–9.21). Unchanged ventricles at malfunction were associated with a frontal shunt (41% vs 28%, p < 0.001), programmable valve (17% vs 9%, p = 0.011), non siphoning shunt (85% vs 66%, p < 0.001), larger baseline FOR (0.44 ± 0.12 vs 0.38 ± 0.11, p < 0.001), no prior shunt infection (87% vs 76%, p = 0.003), and no prior shunt modifications (68% vs 52%, p < 0.001). Patients with a frontal shunt (OR 1.67, 95% CI 1.08–2.70, p = 0.037), programmable valve (OR 2.63, 95% CI 1.32–5.26, p = 0.007), nonsiphoning shunt at malfunction (OR 2.76, 95% CI 1.63–4.67, p < 0.001), larger baseline FOR (OR 3.13, 95% CI 2.21–4.43, p < 0.001), and no prior shunt infection (OR 2.34, 95% CI 1.27–4.30, p = 0.007).
Those with a frontal shunt, programmable valve, non-siphoning shunt, large baseline ventricles, and no prior shunt infection were more likely than others to have unchanged ventricles at shunt failure in a multicenter cohort of children with shunt malfunction.
Reference:thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/28/6/article-p703.xml
