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Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience.

Publication ,  Journal Article
McGirt, MJ; Leveque, J-C; Wellons, JC; Villavicencio, AT; Hopkins, JS; Fuchs, HE; George, TM
Published in: Pediatr Neurosurg
May 2002

BACKGROUND: Innovations in shunt technology and neuroendoscopy have been increasingly applied to shunt management. However, the relative life span of shunts and the etiology of shunt failure have not been characterized recently. METHODS: We reviewed the records of all shunting procedures at our institution between January 1992 and December 1998. Independent predictors of shunt failure were analyzed via multivariate Cox regression analysis in 836 shunting procedures. Independent predictors of the etiology of failure (infection, proximal obstruction, distal malfunction) were analyzed via multivariate logistic regression analysis in the 383 shunts which failed. RESULTS: A total of 353 pediatric patients underwent 308 shunt placements and 528 revisions. The risk (hazard ratio; HR) of shunt failure decreased as a function of time in both primary placements and revised shunts. In failed shunts, the odds of infection decreased 4-fold per year of shunt function, while the odds of distal malfunction increased 1.45-fold per year. Increasing number of shunt revisions (HR 1.31, p < 0.05), decreasing patient age in years (HR 1.04, p < 0.001), gestational age <40 weeks (HR 2.15, p < 0.001) but not the etiology of hydrocephalus were associated with an increased risk of shunt failure. Revisions versus primary placements, Dandy-Walker cysts and gestational age <40 weeks were independently associated with proximal, distal and infectious causes of failure, respectively. CONCLUSIONS: The long-term shunt revision rates observed here are similar to those reported over the past 2 decades. Shunt life span remains poorer in shunt revisions and in younger patients. Patient characteristics may suggest a specific risk and mechanism of failure, aiding in the long-term management of shunted hydrocephalus.

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Published In

Pediatr Neurosurg

DOI

ISSN

1016-2291

Publication Date

May 2002

Volume

36

Issue

5

Start / End Page

248 / 255

Location

Switzerland

Related Subject Headings

  • Treatment Failure
  • Survival Rate
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Male
  • Infant
  • Hydrocephalus
  • Humans
  • Follow-Up Studies
  • Female
 

Citation

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McGirt, M. J., Leveque, J.-C., Wellons, J. C., Villavicencio, A. T., Hopkins, J. S., Fuchs, H. E., & George, T. M. (2002). Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience. Pediatr Neurosurg, 36(5), 248–255. https://doi.org/10.1159/000058428
McGirt, Matthew J., Jean-Christophe Leveque, John C. Wellons, Alan T. Villavicencio, John S. Hopkins, Herbert E. Fuchs, and Timoth M. George. “Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience.Pediatr Neurosurg 36, no. 5 (May 2002): 248–55. https://doi.org/10.1159/000058428.
McGirt MJ, Leveque J-C, Wellons JC, Villavicencio AT, Hopkins JS, Fuchs HE, et al. Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience. Pediatr Neurosurg. 2002 May;36(5):248–55.
McGirt, Matthew J., et al. “Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience.Pediatr Neurosurg, vol. 36, no. 5, May 2002, pp. 248–55. Pubmed, doi:10.1159/000058428.
McGirt MJ, Leveque J-C, Wellons JC, Villavicencio AT, Hopkins JS, Fuchs HE, George TM. Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience. Pediatr Neurosurg. 2002 May;36(5):248–255.
Journal cover image

Published In

Pediatr Neurosurg

DOI

ISSN

1016-2291

Publication Date

May 2002

Volume

36

Issue

5

Start / End Page

248 / 255

Location

Switzerland

Related Subject Headings

  • Treatment Failure
  • Survival Rate
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Male
  • Infant
  • Hydrocephalus
  • Humans
  • Follow-Up Studies
  • Female