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

Öz

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.

Anahtar Kelimeler

• Hidrosefali
• şant enfeksiyonu
• hidrosefali prognozu

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

Öz

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.

Anahtar Kelimeler

• Hydrocephalus
• shunt infection
• prognosis of hydrocephalus.

Kaynakça

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