Shunt Infections

Shunt infections occur in about 10% of shunt procedures in children but are much less common in adults. They may occur at any time in relation to shunt placement and have been reported more than 10 years after shunt placement. The bacteria causing such infections are typically skin flora such as Staphylococcus epidermidis and Propionibacterium spp.

Most authorities recommend removing the entire shunt system in these circumstances, using an external diversion system during treatment with appropriate intravenous antibiotics, and placement of a new shunt after an interval from several days to a couple of weeks depending on a number of factors, including the virulence of the identified organism and the sterilization of CSF on serial cultures.

Other complications with shunts include the following:

• Occasional seizures (1%) that can result from the cortical irritation from catheter placement.

• Ascites (with peritoneal shunts) or pleural effusions (with pleural shunts) from poor local absorption of CSF.

• Bowel perforation, which can occur at the time of shunt insertion or even years later from gra dual erosion of the shunt tubing into the bowel lumen.

• Specific problems with atrial shunting, including bacteremia and endocarditis as well as shunt nephritis, which for poorly understood reasons appears to result from the deposition of antigen-antibody complexes in the renal glomeruli following shunt infection. Pulmonary emboli (which can be septic) can also occur, leading to pulmonary infarction.

Outcome in hydrocephalus is related to the increased ICP as well as the primary cause of the condition. Deaths from hydrocephalus in countries in which neurosurgeons and shunt are available are uncommon. One study cited an 80-90% 5-year survival rate in children with hydrocephalus. Most data on mortality are set in the context of treatment complications. Death from shunt failure is rare, with reported rates of approximately 1%.

Cognitive deficits are difficult to interpret in the context of underlying brain abnormalities. One study examining children with arrested (untreated) hydro-cephalus found 25% with IQs below 50 and 45% with IQs higher than 85%. Another study examining children with treated hydrocephalus found 72% with IQs between 70 and 100 and 32% with IQs higher than 100. Only 4% had IQs below 70.

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