Türk Nöroşirürji Dergisi 2006 , Vol 16 , Num 3
Ventriculoperitoneal Shunt Dysfunctions
Adem YILMAZ, Ali Genç HACI, Ahmet Murat MÜSLÜMAN, İbrahim ÇOLAK, Yüksel ŞAHİN, Yunus AYDIN
Şişli Etfal Eğitim Araştırma Hastanesi Nöroşirürji Kliniği, İstanbul OBJECTIVE: In this retrospective study we presented causes of Shunt dysfunction in patients who underwent ventriculoperitoneal shunt operation for hydrocephalus.

METHODS: Etiologies, clinical data, radiological findings, causative factors for complications, and follow-up registries of 309 patients who underwent ventriculoperitoneal shunt operation for hydrocephaly between 1988-2006 in our clinics were examined retrospectively. They consisted of 166 female and 143 male patients whose age ranges were 1 day-76 years (mean age 21,5 years). Hundred and one patients were less than 1 year of age, while number of cases within 1-18 and > 65 year- age groups comprised of 113 and 65 cases respectively. Follow-up periods of patients range between 21 days and 8 years.

RESULTS: When we examined etiologic factors of 309 patients included in our series, development of hydrocephalus due to postmeniningitis sequelae (n= 87), myelomeningocele (n=81), tumoral processes (n=36), normal pressure-hydrocephalus (n= 35), subarachnoidal bleeding (n= 33), congenital anomalies (n= 28), and aqueduct stenosis (n=9) was detected. The cases underwent 401 surgical intervention in all. For 64 cases surgical revisions were performed for 2-4 times or more, while the remaining 245 patients didn't require nay revision at all. When we investigated the causes of ventriculoperitoneal shunt dysfunction, we revealed ventricular tip occlusion in 33 (51,5 %), infection in 17 (15,7 %), peritoneal tip occlusion in 10 (15,7 %), and excessive discharge in 4 (6,3 %) patients respectively. Revisions were performed between 2 days and 8 years after the first surgical intervention. When we explored the causes of shunt dysfunction during revisions, the pump, ventricular catheter, and at last peritoneal tip were checked. Samples of CSF were taken from all patients during revisions. CSF samples from pump reservoirs were obtained and analysed for the presumably infective patients. Appropriate antibiotherapy was initiated according to the results of susceptibility tests.

CONCLUSION: Appropriate antibiotherapy should be instituted before ventriculoperitoneal shunt operations in consideration of the preoperative health status of the patient. Selection of proper quality pump together with compliance to certain criteria during placement of ventricular and peritoneal catheters have favorable impact on the prognosis. Anahtar Kelimeler : Hydrocephalus, Ventriculoperitoneal shunt, Shunt dysfunction