Hidrosefali Etiyolojisinin Şant Enfeksiyonu, Disfonksiyonu ve Prognoz Üzerine Etkisi, 7 Yıllık Takip

Abstract

Giriş: Hidrosefali, beyin-omurilik sıvısı (BOS) üretiminin artması, emiliminin bozulması veya dolaşım yollarında tıkanıklık gibi çeşitli nedenlerle ortaya çıkabilir. Hidrosefalinin en sık cerrahi tedavisi ventriküloperitoneal şant (VPŞ) uygulamasıdır. Bu çalışmada, hidrosefali nedeniyle VPŞ yerleştirilen ve en az 7 yıl izlenen hastaların kısa ve uzun dönem sonuçları değerlendirilmiş, prognozu etkileyen faktörler araştırılmıştır. Metod: Çalışmaya Ocak 2011 – Aralık 2016 tarihleri arasında hidrosefali nedeniyle ventriküloperitoneal şant takılan 196 hasta dahil edilmiştir. Hastalar şant takılma etiyolojisine göre kommunike ve non kommunike olmak üzere iki gruba ayrılmıştır. Bulgular: Hastaların %45,9’u kadın, %54,1’i erkekti ve yaş ortalaması 152,1 ± 239,3 aydı. Ortalama cerrahi sayısı 2,05 ± 1,74 olup, %20,4’üne eksternal ventriküler drenaj uygulanmıştır. Hastaların %20,9’unda en az bir şant enfeksiyonu öyküsü mevcuttu. Hidrosefali tipine göre %24’ü obstrüktif, %76’sı kommunike olarak sınıflandırılmıştır. En sık etiyolojiler spina bifida (%33,2), konjenital nedenler (%17,9) ve akuadukt stenozu (%11,7) idi. Kommunike hidrosefali daha küçük yaş grubunda daha sık görülmekteydi (p = 0.003). Cinsiyet dağılımı kommunike tipte dengeliyken, obstrüktif tipte erkek baskınlığı gözlendi (p = 0.020). İki grup arasında operasyon sayısı, enfeksiyon oranı, eksternal ventriküler drenaj gereksinimi ve mortalite açısından anlamlı fark izlenmedi. Operasyon sayısı arttıkça eksternal ventriküler drenaj ihtiyacı, enfeksiyon oranı ve erken dönem mortalite ile anlamlı ilişki saptandı (p < 0.01). Ayrıca enfeksiyon artışı mortalite ile de ilişkili bulundu (p < 0.01). Ortalama takip süresi 93,1 ± 40,9 ay olup, %14,3 oranında mortalite izlenmiştir. Sonuç: Hidrosefali etiyolojisi ve demografik faktörler, şant enfeksiyonları ve prognoz üzerinde etkili olup, gelecekteki çalışmaların, şant komplikasyonlarına bağlı mortaliteyi detaylı incelemesi, tedavi yaklaşımlarını geliştirmeye katkı sağlayacaktır.

Keywords

• Hidrosefali
• şant enfeksiyonu
• hidrosefali prognozu

The Impact of Hydrocephalus Etiology on Shunt Infection, Malfunction, and Prognosis: A 7-Year Follow-Up Study

Abstract

Introduction: Hydrocephalus can result from various causes, including increased cerebrospinal fluid production, impaired absorption, or obstruction within the cerebrospinal fluid (CSF) pathways. The most common surgical intervention for hydrocephalus is ventriculoperitoneal shunt placement. In this study, we evaluated the short- and long-term outcomes of patients who underwent ventriculoperitoneal shunt implantation for hydrocephalus and were followed for a minimum of seven years. We also investigated the prognostic factors influencing patient outcomes. Methods: This retrospective study included 196 patients who underwent ventriculoperitoneal shunt surgery for hydrocephalus between January 2011 and December 2016. Based on the etiology, patients were categorized into two groups: communicating and non-communicating hydrocephalus. Results: Complicated hydrocephalus was significantly more common in younger patients (p = 0.003). While gender distribution was balanced in the communicating group, obstructive hydrocephalus showed a male predominance (p = 0.020). No significant differences were observed between the groups in terms of the number of operations, infection rates, need for external ventricular drainage, or mortality. As the number of surgical interventions increased, there was a significant association with the need for external ventricular drainage, higher infection rates, and early mortality (p < 0.01). Moreover, an increased incidence of infection was also significantly associated with mortality (p < 0.01). The mean follow-up duration was 93.1 ± 40.9 months, and the overall mortality rate was 14.3%. Conclusion: The etiology of hydrocephalus and demographic characteristics significantly influence shunt-related infections and overall prognosis. Future studies focusing on mortality related to shunt complications in greater detail may contribute to the development of more effective treatment strategies.

Keywords

• Hydrocephalus
• shunt infection
• prognosis of hydrocephalus.

References

1. 1.Kim M, Choi JH, Park JC, et al. Ventriculoperitonealshunt infection and malfunction in adult patients:incidence, risk factors, and long-term follow-up ofsingle institution experience. Neurosurg Rev.2024;47(1):269. doi:10.1007/s10143-023-02168-z.Cited in: PMID: 37956233.
2. 2.Rekate HL. A contemporary definition andclassification of hydrocephalus. Semin Pediatr Neurol.2009 Mar;16(1):9–15.doi:10.1016/j.spen.2009.01.002. Cited in: PMID:19218027.
3. 3.Rekate HL. Hydrocephalus in children:Pathophysiology and treatment. Pediatr Clin NorthAm. 1992;39(3):677–703. doi:10.1016/S0031-3955(16)38325-7. Cited in: PMID: 1593165.
4. 4.Kahle KT, Kulkarni AV, Limbrick DD Jr, et al.Hydrocephalus in children. Lancet.2016;387(10020):788–799. doi:10.1016/S0140-6736(15)60694-8. Cited in: PMID: 26382940.
5. 5.Mulugeta H, et al. Pattern and outcome of pediatrichydrocephalus: A tertiary center experience. Ethiop JHealth Sci.2019;29(1):831–838.doi:10.4314/ejhs.v29i1.18. Cited in: PMID: 31818578.
6. 6.Bidabadi E, Mashouf M, et al. Hydrocephaluspatterns in Iranian children: A 10-year review. IranianJ Child Neurol.2013;7(3):41–46. Cited in: PMID:24684874.
7. 7.Mitchell LE, Adzick NS, Melchionne J, et al. Spinabifida and gender: A US-based epidemiologic study.Pediatr Neurosurg. 2004;40(6):24750.doi:10.1159/000082479. Cited in: PMID: 15217472.
8. 8.Hamilton MG. Treatment of hydrocephalus in adults. In: Semin Pediatr Neurol. 2009 Mar;16(1):34–41. WBSaunders.

9. 9.Aydin Ozturk P, Asena M. Determination ofventriculoperitoneal shunt dysfunction using opticnerve sheath diameter measurement on CT scan inpediatric patients with hydrocephalus. Childs NervSyst. 2021;37:1895–900. Cited in: PMID: 33863114.
10. 10.Erol FS, Ozturk S, Akgun B, et al.Ventriculoperitoneal shunt malfunction caused byfractures and disconnections over 10 years of follow- up. Childs Nerv Syst. 2017;33:475–81. Cited in: PMID: 28166991.
11. 11.Piatt Jr JH, Garton HJ. Clinical diagnosis ofventriculoperitoneal shunt failure among childrenwith hydrocephalus. Pediatr Emerg Care.2008;24(4):201–10. Cited in: PMID: 18363125.
12. 12.Chimaliro S, Hara C, Kamalo PJA. Mortality andcomplications 1 year after treatment of hydrocephaluswith endoscopic third ventriculostomy andventriculoperitoneal shunt in children at QueenElizabeth Central Hospital, Malawi. Acta Neurochir.2023;165(1):61–9. Cited in: PMID: 37318229.
13. 13.Akade E, Aslani F, Verdi K, et al. Diagnosis ofchoroid plexus papilloma: Current perspectives andfuture directions. Cancer Pathog Ther. 2023;2(3):173–9.doi:10.1016/j.cpt.2023.09.005.
14. 14.Blount JP, Maleknia P, Hopson BD, et al.Hydrocephalus in spina bifida. NeurolIndia.2021;69(Suppl 2):S367–S71. Cited in: PMID:33775501.
15. 15.Kahilogullari G, Tuna H, Taskapilioglu O, et al.Etiology of hydrocephalus in adult patients: anepidemiologic study. Turkish Neurosurgery.2008;18(1):31–5. Cited in: PMID: 18382982.
16. 16.Rekate HL. A contemporary definition andclassification of hydrocephalus. Semin Pediatr Neurol.2009 Mar;16(1):9–15.doi:10.1016/j.spen.2009.01.002. Cited in: PMID:19218027.
17. 17.Isaacs AM, Riva-Cambrin J, Yavin D, et al. Age-specific etiology of pediatric hydrocephalus: 2001–2011. J Neurosurg Pediatr. 2018;22(2):206–15. Citedin: PMID: 29775191.
18. 18.Langel SN, Blasi M, Permar SR. Maternal immuneprotection against infectious diseases. Cell HostMicrobe.2022;30(5):660–74.doi:10.1016/j.chom.2022.04.007.
19. 19.Davson H, Welch K, Segal MB. Physiology andpathophysiology of the cerebrospinal fluid. No Title.
20. 20.Warf BC, Alkire BC, Bhai S,et al. Costs and benefitsof neurosurgical intervention for infant hydrocephalusin sub-Saharan Africa. J Neurosurg Pediatr.2011;8(5):509–21. doi:10.3171/2011.8.PEDS11163.
21. 21.Kulkarni AV, Drake JM, Lamberti-Pasculli M.Cerebrospinal fluid shunt infection: a prospectivestudy of risk factors. J Neurosurg. 2001;94(2):195–201.doi:10.3171/jns.2001.94.2.0195.
22. 22.Volpe JJ. Neural tube formation and prosencephalicdevelopment. Neurol Newborn. 1995;3-42.
23. 23.Mulugeta B, Seyoum G, Mekonnen A, et al.Assessment of the prevalence and associated riskfactors of pediatric hydrocephalus in diagnosticcenters in Addis Ababa, Ethiopia. BMC Pediatr.2022;22(1):145. doi:10.1186/s12887-022-03212-6.
24. 24.Bidabadi E. Relative frequency of hydrocephalus inRasht pediatric patients. Iranian J Child Neurol.2010;4(4):37–41.
25. 25.Greene ND, Massa V, Copp AJ. Understanding thecauses and prevention of neural tube defects: Insightsfrom the splotch mouse model. Birth Defects Res A ClinMol Teratol. 2009;85(4):322–30.
26. 26.Tully HM, Doherty D, Wainwright M. Mortality inpediatric hydrocephalus. Dev Med Child Neurol.2022;64(1):112–7. doi:10.1111/dmcn.14975.
27. 27.Dewan MC, Rattani A, Mekary R, et al. Globalhydrocephalus epidemiology and incidence:systematic review and meta-analysis. J NeurosurgPediatr. 2018;21(5):574-85.doi:10.3171/2018.1.PEDS1831. Cited in: PMID:29537909.
28. 28.Kurtuluş A, Tekiner A, Kul H, et al. Evaluation ofshunt revisions in pediatric hydrocephalus cases.Eskisehir Med J. 2022;3(1):5–10.doi:10.48176/esmj.2022.46.
29. 29.Simon TD, Butler J, Whitlock KB, et al.Hydrocephalus Clinical Research Network. Risk factorsfor first cerebrospinal fluid shunt infection: findingsfrom a multi-center prospective cohort study. JPediatr.2014;164(6):1462–8.e2.doi:10.1016/j.jpeds.2014.02.013.
30. 30.Stone JJ, Walker CT, Jacobson M, et al. Revision rateof pediatric ventriculoperitoneal shunts after 15 years.J Neurosurg Pediatr. 2013;11(1):15–9.doi:10.3171/2012.9.PEDS1298.