Clinical analysis of shunted hydrocephalic neonates and sucklings--observation on obstruction and infection of shunting system

Although ventriculoperitoneal (V-P) shunt is common as the surgical procedure for hydrocephalus, mechanical malfunction and infection are the most significant problems. Despite the current use of variety of mechanical shunting systems, shunt malfunction remains a major problem in pediatric neurosurgical practice. Pathological lesions associated with malfunctioning shunts have been studied only infrequently. From April 1980 to December 1987, we experienced 96 cases of V-P shunt in neonates and suckling. The therapeutic results of shunting and causes of initial shunt revision in those cases with nontumoral hydrocephalus were studied. Of 96 cases, which included 55 cases of congenital and 41 cases of acquired hydrocephalus, in which a V-P shunt had been performed, those cases with no history of shunt revision or with only elective shunt revision during the 5-year follow-up period were classified as successful shunt. The 56 of 96 cases (58.3% successful shunts included 15 of 24 patients with myelomeningocele, 7 of 10 with encephalocele, 12 of 21 with various types of cerebral anomaly, 12 of 22 with posthemorrhagic hydrocephalus and 10 with postmeningitic hydrocephalus. There were 12 successful shunts performed in 27 premature and 44 in 69 mature infants. The 40 patients (41.7% with non-elective shunt revision included 5 with breakdown of the sutured scalp with cerebrospinal fluid leakage, 20 with obstruction of the shunt system (14 ventricular side, 6 abdominal side, and 15 with infection. During the 5-year follow-up period 11 died and 85 survived 88.5%), of whom 43 (44.8%) showed normal intellectual development and 42 (43.7%) showed developmental disability.