Background/Aims: Obstruction is the most common complication of ventriculoperitoneal shunts in patients with hydrocephalus. Despite technical advances, rates of obstruction have barely decreased and remain at over 40% of cases. Patients suffering from preterm-related posthaemorrhagic hydrocephalus are considered a group with a particularly high risk of obstruction. The aim of the present study was to review our series of patients with preterm-related posthaemorrhagic hydrocephalus and analyse the occurrence of the first ventricular shunt obstruction as well as the related clinical and radiological factors. Methods: We conducted a retrospective review of 103 cases treated from 1982 to 2010. Descriptive analysis, raw and adjusted bivariate correlations and survival analysis were performed. Results: Over the course of the follow-up, 42 patients presented at least one episode of obstruction that required proximal revision. Medium-opening pressure valves were associated with a higher rate of obstruction compared to low-opening pressure valves; however, in our series this association became statistically significant only in patients with a weight of over 2,000 g at the time of surgery (odds ratio 6.75). The occurrence of previous infection and the development of late slit ventricle syndrome were also significantly associated with obstruction of the ventricular catheter (odds ratios 3.35 and 4.27, respectively). Conclusions: Rates of shunt obstruction in preterm-related posthaemorrhagic hydrocephalus remain high but do not seem to be higher than in other groups of paediatric hydrocephalus. Prevention of infection and the use of the appropriate type of valve design can help to decrease the incidence of proximal shunt obstruction, which in turn could decrease the incidence of symptomatic slit ventricle syndromes.

Keywords:
Shunt obstruction, Posthaemorrhagic hydrocephalus, Infection, Slit ventricle
1.
Drake J, Kestle J, Milner R, Cinalli G, Boop F, Piatt J Jr, Haines S, Schiff SJ, Cochrane DD, Steinbok P, MacNeil N: Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 1998;43:294–305.
2.
Shah SS, Hall M, Slonim AD, Hornig GW, Berry JG, Sharma V: A multicenter study of factors influencing cerebrospinal fluid shunt survival in infants and children. Neurosurgery 2008;62:1095–1102.
3.
Kestle J, Drake J, Milner R, Sainte-Rose C, Cinalli G, Boop F, Piatt J, Haines S, Schiff S, Cochrane D, Steinbok P, MacNeil N: Long-term follow-up data from the Shunt Design Trial. Pediatr Neurosurg 2000;33:230–236.
4.
Kestle JRW, Drake JM, Cochrane DD, Milner R, Walker ML, Abbott R 3rd, Boop FA; Endoscopic Shunt Insertion Trial participants: Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial. J Neurosurg 2003;98:284–290.
5.
Pollack I, Albright A, Adelson P, Group H-MI: A randomized, controlled study of a programmable shunt valve versus a conventional valve for patients with hydrocephalus. Neurosurgery 1999;45:1399–1411.
6.
Piatt JH Jr, Carlson CV: A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience. Pediatr Neurosurg 1993;19:233–241.
7.
Tuli S, Drake J, Lawless J, Wigg M, Lamberti-Pasculli M: Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg 2000;92:31–38.
8.
Reinprecht A, Dietrich W, Berger A, Bavinzski G, Weninger M, Czech T: Posthemorrhagic hydrocephalus in preterm infants: long-term follow-up and shunt-related complications. Childs Nerv Syst 2001;17:663–669.
9.
Papile LA, Munsick-Bruno G, Schaefer A: Relationship of cerebral intraventricular hemorrhage and early childhood neurological handicaps. J Pediatr 1983;103:273–277.
10.
McMenamin JB, Shackelford GD, Volpe JJ: Outcome of neonatal intraventricular hemorrhage with periventricular echodense lesions. Ann Neurol 1984;15:285–290.
11.
Kuban K, Sanocka U, Leviton A, Allred EN, Pagano M, Dammann O, Share J, Rosenfeld D, Abiri M, DiSalvo D, Doubilet P, Kairam R, Kazam E, Kirpekar M, Schonfeld S: White matter disorders of prematurity: association with intraventricular hemorrhage and ventriculomegaly. The Developmental Epidemiology Network. J Pediatr 1999;134:539–546.
12.
Vural M, Yilmaz I, Ilikkan B, Erginoz E, Perk Y: Intraventricular hemorrhage in preterm newborns: risk factors and results from a University Hospital in Istanbul, 8 years after. Pediatr Int 2007;49:341–344.
13.
Pollack I, Albright A, Adelson P: A randomized, controlled study of a programmable shunt valve versus a conventional valve for patients with hydrocephalus. Hakim-Medos Investigator Group. Neurosurgery 1999;45:1399–1411.
14.
Martínez-Lage JF, Almagro MJ, Del Rincón IS, Pérez-Espejo MA, Piqueras C, Alfaro R, Ros de San Pedro J: Management of neonatal hydrocephalus: feasibility of use and safety of two programmable (Sophy and Polaris) valves. Childs Nerv Syst 2008;24:549–556.
15.
Di Rocco C, Marchese E, Velardi F: A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus. Cooperative survey of the 1991–1992 Education Committee of the ISPN. Childs Nerv Syst 1994;10:321–327.
16.
Rekate HL: The slit ventricle syndrome: advances based on technology and understanding. Pediatr Neurosurg 2004;40:259–263.
17.
Kurtom KH, Magram G: Siphon regulatory devices: their role in the treatment of hydrocephalus. Neurosurg Focus 2007;22:E5.
18.
Vanaclocha V, Sáiz-Sapena N, Leiva J: Shunt malfunction in relation to shunt infection. Acta Neurochir (Wien) 1996;138:829–834.
19.
Rekate HL: Classification of slit-ventricle syndromes using intracranial pressure monitoring. Pediatr Neurosurg 1993;19:15–20.
20.
Rekate HL: Shunt-related headaches: the slit ventricle syndromes. Childs Nerv Syst 2008;24:423–430.
21.
Gough J, Walker DG, Theile R, Tomlinson FH: The role of cranial expansion for craniocephalic disproportion. Pediatr Neurosurg 2005;41:61–69.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.