200 Age as a Novel Risk Factor for Revision of Ventriculopleural Shunt in Pediatric Patients. (August 2016)

• Record Type: Journal Article
• Authors: Melamed, Edward F.; Christian, Eisha; Krieger, Mark D.; Berry, Cherisse; Yashar, Parham; McComb, J. Gordon
• Is Part Of: Clinical neurosurgery. Volume 63(2016)Supplement 1
• Publication Date: 2016-08
• Subjects: Nervous system -- Surgery -- Congresses; Neurosurgery; Nervous system -- Surgery; Neurologie; Congresses; Conference papers and proceedings; 617.48
• DOI: 10.1227/01.neu.0000489769.74513.e8
• Languages: English
• ISSNs: 0069-4827

Abstract

Abstract : INTRODUCTION: The first choice for distal end location of a cerebrospinal fluid-diverting device is the abdomen. However, for patients in whom the peritoneal cavity is not suitable, a ventriculopleural shunt (VPl) is an alternative. METHODS: With institutional review board approval we performed a retrospective review of all patients with ventriculopleural shunts inserted at our institution from 1977 to 2013. RESULTS: One-hundred thirty-one (78 male) patients were identified. Mean age at insertion of VPl was 14 ± 5 years. Before VPl insertion, 58 patients with available preoperative data had experienced of mean of 2 ± 3 revisions. These patients underwent a mean of 1 ± 1 subsequent revisions of their VPl ( P < .01). Fifty-nine of 131 (45%) patients underwent revision of VPl; malfunction 32 of 59 (54%), pleural effusion 18 of 59 (31%), and infection 9 of 59 (15%). Median revision-free duration was 3.6 years. All effusions required the distal end of the shunt be removed from the pleural space, in contrast to 20% of other indications ( P < .001). Binary regression found that, for each additional year in age at the time of VPl insertion, patients experienced an almost 10% reduced risk of revision (Exp B = 0.91; CI, 0.84-1.00). More precisely, 11 years of age was the threshold value at which revision rate differentiated. Among 112 patients with minimum 1 year follow-up, 38 of 82 (46%) patients 11 years or older underwent revision in contrast to 21 of 30 (70%) under 11 ( P < .05). Strengthening this finding, binary regression found a risk ratio for revision of 2.9 (CI, 1.1-7.5) for patients under 11. CONCLUSION: The mean number of revisions dropped significantly after VPl shunt insertion. Malfunction accounted for the majority of indications for VPl revision, but the site of distal drainage was changed mainly in the case of pleural effusions. Younger patients in our population experienced a higher risk for revision, with the rate differentiating at 11 years.