• Paul Klimo, Garrett T Venable, and Nicholas Rossi.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:229-30.

IntroductionSurgery for cerebrospinal fluid diversion is the most common procedure performed by pediatric neurosurgeons. The failure rates for shunts remain frustratingly high, resulting in a negative burden to patients, families, providers, and health care systems. The goal of this study was to quantify the risk of a shunt malfunction in patients with an existing shunt who undergo an elective intradural operation.MethodsAll elective intradural surgeries (cranial and spinal) at Le Bonheur Children's Hospital from January 2010 through June 2014 were reviewed to identify those patients that had a functional ventricular shunt at the time of surgery. Patient records were reviewed to collect demographic, surgical, clinical, radiological, and pathological data, including all details related to any subsequent shunt revision surgery. The primary outcome was all-cause shunt revision (ie, malfunction or infection) within 90 days of elective intradural surgery.ResultsOne hundred fifty elective intradural surgeries were identified in 109 patients during the study period. Thirteen patients (11.9%, 12 male) experienced 15 shunt malfunctions (10%) within 90 days of elective intradural surgery. These 13 patients underwent 12 craniotomies, 2 endoscopic fenestrations for loculated hydrocephalus, and 1 laminectomy for dorsal rhizotomy. Median time to failure was 13 days with 7 of 15 patients failing within 5 postoperative days. Those patients that failed were younger (median, 6.5 years (range, 0.33-26) vs median, 11.87 years (range, 0.58-34), had a shorter time interval from their previous shunt surgery (median, 10 months (range, 0-81) vs median, 20 months (range, 0-238), and underwent a greater percentage of intraventricular surgery (79% vs 61%).ConclusionThis is the first study to quantify the risk of a shunt malfunction after elective intradural surgery. The 90-day all-cause shunt failure rate (per procedure) was 10% with nearly half of the failures occurring within the first 5 postoperative days. Possible risk factors for shunt malfunction after elective intradural surgeries are intraventricular surgical approach, shorter time since last shunt-related surgery, and young age.

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