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Mechanical complications of cerebrospinal fluid shunt. Differences between adult and pediatric populations: myths or reality?

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Abstract

Objective

Shunt malfunctions seem more frequent in children (44 to 81%) than in adults (18 to 29%). Because of discrepancies between studies, it is not possible to affirm this disparity. The objective was to verify whether the incidence of cerebrospinal fluid (CSF) shunt malfunctions is higher in children than adults.

Methods

We present a retrospective series of child and adult patients who underwent CSF shunt placement between 2000 and 2013 with a Sophysa SM8® valve.

Results

599 adults and 98 children (sex ratio 1.28) underwent CSF shunt placement. Age at first surgery ranged between 1 day of life and 90 years (mean of 55.8 years, SD 25.8, median 64.8 years). The mean follow-up was 4 years (SD 4.264, 0–16; median 3 years). The cumulative complication rate was 25.5% (178/697). Mechanical complications were disconnection (25.1%), migration (11.8%), intracranial catheter obstruction (8.9%) and malposition (8.4%). The mean delay for the first revision was 1.90 years (0–13.9), (SD 2.73, median 0.5). The probability of shunt failure was 65% at 10 years in the child group and 36% at 10 years in the adult group. Moreover, in the child group, 33% of revisions occurred during the first year after shunt placement versus 17% in the adult group. Thus, the probability of shunt failure was higher in children than in adults (log-rank test, p < 0.001).

Conclusions

This is the first retrospective study, comparing children and adults undergoing CSF shunt using the same valve, able to confirm the higher rate of complications in children.

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Authors and Affiliations

  1. Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France

    Guillaume Coll, Francis Abed Rabbo, Aurélien Coste, Jean Chazal & Laurent Sakka

  2. Laboratoire d’Anatomie et d’Organogenèse, Laboratoire de Biophysique Sensorielle, NeuroDol, faculté de médecine, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France

    Francis Abed Rabbo, Jean Chazal & Laurent Sakka

  3. Service de Neurochirurgie, CHU Grenoble-Alpes, F-38700, Grenoble, France

    Emmanuel de Schlichting

  4. Service de Radiologie Pédiatrique, CHU Clermont-Ferrand, F-63000, Clermont-Ferrand, France

    Jean-Marc Garcier

  5. Service de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Robert Debré, Assistance Publique–Hôpitaux de Paris (AP-HP), F-75005, Paris, France

    Hugo Peyre

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  1. Guillaume Coll
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Correspondence to Francis Abed Rabbo.

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Ethics approval

This paper reports a retrospective study, formal consent is not required for this type of study. Moreover, this retrospective study was approved by our institutional review board and did not raise ethical issues and fell outside the scope of the rules governing biomedical research (articles L.1121-1-1 and R1121-3 of the Code of Public Health).

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

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Supplementary Information

Supplementary Figure 5.

Population pyramid with demographic characteristics of the patients. The 697 patients were split according to age and sex (JPG 151 kb).

Supplementary Figure 6:

Actuarial probability of shunt survival time according to Kaplan Meier method in the overall population. The risk of failure is maximal during the first year (88%) and lowers to 44% at 10 years. (JPG 98 kb).

Supplementary Figure 7

Violin plot comparing the probability density of the age at surgery for pediatrics and adults, smoothed by a kernel density estimator. The mean is represented by a black diamond. The distribution of the population is represented by points. (JPG 132 kb).

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Coll, G., Abed Rabbo, F., de Schlichting, E. et al. Mechanical complications of cerebrospinal fluid shunt. Differences between adult and pediatric populations: myths or reality?. Childs Nerv Syst 37, 2215–2221 (2021). https://doi.org/10.1007/s00381-021-05125-8

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  • DOI: https://doi.org/10.1007/s00381-021-05125-8

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