COVID 19 ve Pediatrik Hastalarda Şant Disfonksiyonu: Pandemiden Edinilen Tecrübe

Yıl 2025, Cilt: 16 Sayı: 4, 576 - 581, 01.01.2026

Halil Kul , Medine Ezgi Öcal , Harun Demirci , Berkcan Demir , Yusuf Küçük , Pınar Özışık

https://doi.org/10.18663/tjcl.1821445

https://izlik.org/JA78JP97JR

Öz

Amaç: Ventriküloperitoneal (VP) şant cerrahisi, hidrosefali tedavisinde en yaygın kabul gören yöntemdir. Şant disfonksiyonu, farklı etiyolojilere sahip yaygın bir komplikasyondur. Bu çalışma, pandemi döneminde şant disfonksiyonu nedeniyle cerrahi uygulanan ve ameliyat öncesi dönemde COVID-19 pozitif olan pediatrik hastaları değerlendirmeyi amaçlamaktadır.
Materyal-metod: Mart 2020 ile 2023 tarihleri arasında şant disfonksiyonu ön tanısıyla cerrahi tedavi uygulanan hastaların bulguları retrospektif kesitsel bir tasarım ile incelendi. Hastaların yaşı, cinsiyeti, COVID-19 pozitiflik tarihi, başvuru semptomları, BOS bulguları, BOS kültürü, kan testleri ve uygulanan tedaviler hasta dosyaları ve elektronik kayıtlar üzerinden elde edildi.
Bulgular: Ameliyat öncesi dönemde COVID-19 pozitif olan ve VP şant disfonksiyonu gelişen 13 pediatrik hastanın verileri değerlendirildi. Ateş (%61,5) ve emmede azalma/huzursuzluk (%62,5) en sık görülen semptomlardı. İki hastada pozitif BOS kültürü tespit edildi. Biyokimyasal anormallikler arasında D-dimer ve transaminaz yüksekliği gözlendi.
Sonuç: COVID-19, solunum semptomları olmasa bile gastrointestinal ve peritoneal tutulum yoluyla şant disfonksiyonuna katkıda bulunabilir. COVID-19 ve hidrosefali tanısı olan çocuk hastalarda, klinisyenler şant disfonksiyonu olasılığına karşı yüksek şüphe düzeyini korumalıdır.

Anahtar Kelimeler

Hidrosefali , Pediatrik Nöroşirürji , Şant Revizyonu , SARS-CoV-2

COVID-19 and Shunt Dysfunction in Pediatric Patients: Experience From the Pandemic

https://izlik.org/JA78JP97JR

Öz

Aim: Ventriculoperitoneal (VP) shunt surgery is the most widely accepted method for the treatment of hydrocephalus. Shunt dysfunction is a common complication with various etiologies. This study aimed to evaluate pediatric patients who underwent surgery due to shunt dysfunction during the pandemic period and were COVID-19 positive in the preoperative period.
Material and Methods: The findings of the patients who underwent surgical treatment with a preliminary diagnosis of shunt dysfunction between March 2020 and 2023 were examined in the present study. A retrospective cross-sectional design was adopted. Age, sex, date of COVID-19 positivity, symptoms at presentation, CSF findings, CSF culture, blood tests, and applied treatments of the patients were obtained from patient files and electronic records.
Results: Among 13 pediatric patients with VP shunt dysfunction and preoperative COVID-19 positivity, fever (61.5%) and decreased sucking/restlessness (62.5%) were the most frequent symptoms. Two patients had positive CSF cultures. Biochemical abnormalities were observed, including elevated D-dimer and transaminases.
Conclusion: COVID-19 may contribute to shunt dysfunction through gastrointestinal and peritoneal involvement, even in the absence of respiratory symptoms. Clinicians should maintain high suspicion for shunt malfunction in pediatric patients with COVID-19 and hydrocephalus.

Anahtar Kelimeler

Hydrocephalus , Pediatric Neurosurgery , Shunt Revision , SARS-CoV-2

Kaynakça

• Dandy WE, Blackfan KD. An experimental, clinical and pathological study: Part 1.- experimental studies. Am J Dis Child 1914; 8: 406-82.
• Patwardhan RV, Nanda A. Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment. Neurosurgery 2005; 56: 139-45.
• Cengiz S, Erdem Y, Celik H, Tekiner A, Kul H, Kurtulus A et al. Retrospective examination of patients with spontaneous cranial intracerebral hematoma. Turk Neurosurg 2024; 34: [Hocam buradaki sayfa numarasını kontrol edelim].
• Ghritlaharey RK, Budhwani K, Shrivastava DK, Gupta G, Kushwaha AS, Chanchlani R et al. Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children. Pediatr Surg Int 2007; 23: 575-80.
• Hamdan AR. Ventriculoperitoneal shunt complications: a local study at Qena University Hospital: a retrospective study. Egypt J Neurosurg 2018; 33: 1-8.
• Kurtuluş A, Tekiner A, Kul H, Erdem Y, Çelik H, Yıldırım ME et al. Evaluation of shunt revisions in pediatric hydrocephalus cases. Eskisehir Med J 2022; 3: 5-10.
• Baccarella A, Linder A, Spencer R, Jonokuchi AJ, King PB, Maldonado-Soto A et al. Increased intracranial pressure in the setting of multisystem inflammatory syndrome in children, associated with COVID-19. Pediatr Neurol 2021; 115: 48-9.
• Edén A, Kanberg N, Gostner J, Fuchs D, Hagberg L, Andersson LM et al. CSF biomarkers in patients with COVID-19 and neurologic symptoms: a case series. Neurology 2021; 96: e294-300.
• Lin JE, Asfour A, Sewell TB, Hooe B, Pryce P, Earley C et al. Neurological issues in children with COVID-19. Neurosci Lett 2021; 743: 135567.
• Alnajjar AA, Dohain AM, Abdelmohsen GA, Alahmadi TS, Zaher ZF, Abdelgalil AA. Clinical characteristics and outcomes of children with COVID-19 in Saudi Arabia. Saudi Med J 2021; 42: 391.
• Alsohime F, Temsah MH, Al-Nemri AM, Somily AM, Al-Subaie S. COVID-19 infection prevalence in pediatric population: etiology, clinical presentation, and outcome. J Infect Public Health 2020; 13: 1791-6.
• Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z et al. Epidemiology of COVID-19 among children in China. Pediatrics 2020; 145: e20200702.
• Leidman E, Duca LM, Omura JD, Proia K, Stephens JW, Sauber-Schatz EK. COVID-19 trends among persons aged 0–24 years—United States, March 1–December 12, 2020. MMWR Morb Mortal Wkly Rep 2021; 70: 88-94.
• Abdalhadi A, Alkhatib M, Mismar AY, Awouda W, Albarqouni L. Can COVID 19 present like appendicitis? IDCases 2020; 21: e00860.
• Saeed U, Sellevoll H, Young V, Sandbaek G, Glomsaker T, Mala T. Covid-19 may present with acute abdominal pain. Br J Surg 2020; 107: e186-7.
• Tullie L, Ford K, Bisharat M, Watson T, Thakkar H, Mullassery D et al. Gastrointestinal features in children with COVID-19: an observation of varied presentation in eight children. Lancet Child Adolesc Health 2020; 4: e19-20.
• Paff M, Alexandru-Abrams D, Muhonen M, Loudon W. Ventriculoperitoneal shunt complications: a review. Interdiscip Neurosurg 2018; 13: 66-70.
• Chung JJ, Yu JS, Kim JH, Nam SJ, Kim MJ. Intraabdominal complications secondary to ventriculoperitoneal shunts: CT findings and review of the literature. AJR Am J Roentgenol 2009; 193: 1311-17.
• Hanak BW, Bonow RH, Harris CA, Browd SR. Cerebrospinal fluid shunting complications in children. Pediatr Neurosurg 2017; 52: 381-400.
• Guthe S, Pravin S, Darade P, Velho V. Silent migration of ventriculoperitoneal shunt per anus in a child: management and review of literature. Asian J Neurosurg 2018; 13: 446-8.
• Hamming I, Timens W, Bulthuis M, Lely A, Navis GV, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol 2004; 203: 631-7.
• Sungnak W, Huang N, Becavin C, Berg M, Queen R, Litvinukova M et al. SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes. Nat Med 2020; 26: 681-7.
• Puoti MG, Rybak A, Kiparissi F, Gaynor E, Borrelli O. SARS-CoV-2 and the gastrointestinal tract in children. Front Pediatr 2021; 9: 617980.
• Giacomet V, Barcellini L, Stracuzzi M. Gastrointestinal symptoms in severe COVID-19 children. Pediatr Infect Dis J 2020; 39: e317-20.
• Jimenez DG, Rodriguez-Belvis MV, Gonzalez PF, Ortega GD, Segarra O, Benitez EM et al. COVID-19 gastrointestinal manifestations are independent predictors of PICU admission in hospitalized pediatric patients. Pediatr Infect Dis J 2020; 39: e459-62.
• Vecchio AL, Garazzino S, Smarrazzo A, Venturini E, Poeta M, Berlese P et al. Factors associated with severe gastrointestinal diagnoses in children with SARS-CoV-2 infection or multisystem inflammatory syndrome. JAMA Netw Open 2021; 4: e2139974.
• Hallan DR, Rizk E. COVID-19 and ventricular shunt revisions. Cureus 2022; 14: e27150.