PubMed · 7432606
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S C Stein. 1980. Testing cerebrospinal fluid shunt function: a noninvasive technique.. https://doi.org/10.1227/00006123-198006000-00006
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One of the most common causes of shunt malfunction is infection; a major contributing factor to this infection in neonates is scalp necrosis over the valve site. One of the methods recommended to avoid this requires the burying of the valve in the skull bone. We present a case of a long-term complication from this procedure: the shunt slowly disconnected, over a prolonged period, leading to the formation of the fibrous tunnel which enabled the shunt to function intermittently. We recommend that the practice of burying the shunt into the skull bone is be reconsidered.
A consecutive series of 120 patients with infantile hydrocephalus who were submitted to ventriculo-atrial shunting was studied. The average follow-up was 11 years. There was no operative mortality; 7 patients died during the follow-up period, but only in 1 case was the cause of death a consequence of the shunt procedure. The incidence rates of infection and slit ventricle syndrome were 4.2% and 1.8%, respectively. Shunt revision was performed on 253 occasions yielding a revision rate of 2.2 per patient. Of these 253 revisions 167 (66%) took the form of elective lengthening of the atrial catheter. The number of reoperations to adjust the length of the atrial catheter or to revise the distal end of the shunting system is a major disadvantage, which actually favors ventriculo-peritoneal shunting as the primary procedure for the treatment of pediatric hydrocephalus.
It has been hypothesized, and generally accepted, that the final outcome of the treatment of hydrocephalus is to a great extent related to the earliness of intervention and treatment. However, there is special concern regarding the higher risk of infection and shunt malfunctions in neonates as compared with older infants. Therefore, two new shunt systems have been designed specifically to tip the balance in favor of early shunting. The first shunt is made for premature neonates and the second for neonates in general. The general characteristics of these two shunts are: (1) the entire shunt is a low-pressure valve, with double distal slit valves; (2) the shunts are made of soft silicon material; (3) they are of very small configuration, without any compressing elements which may lead to skin necrosis over the shunt; (4) no metal has been used in them, so they are MRI compatible.