Advertisement

Ventricular shunt complications in patients undergoing posterior vault distraction osteogenesis

  • Anthony Azzolini
  • Katie Magoon
  • Robin Yang
  • Scott Bartlett
  • Jordan Swanson
  • Jesse TaylorEmail author
Original Article

Abstract

Purpose

The primary objective of this study is to investigate post-operative morbidity and shunt revision rates of patients with shunt-dependent hydrocephalus (SDH) undergoing posterior vault distraction osteogenesis (PVDO) compared to patients undergoing conventional posterior vault reconstruction (PVR).

Methods

A retrospective case-controlled cohort analysis of all patients with SDH undergoing PVDO and PVR for syndromic or complex craniosynostosis was performed. Demographic information, perioperative variables, distraction protocols, and shunt-related complications—infection, surgical revision of shunt, increased length of stay (LOS), and readmission within 90 days of surgery—were compared using the appropriate statistical tests.

Results

Fourteen patients with ventricular shunts who underwent PVDO and eight patients with shunts who underwent PVR were identified. Shunt-related complication rates were significantly higher with PVDO (n = 5) compared to PVR (n = 0), p = 0.0093. Among the five patients who suffered complications, the most common were shunt infection (n = 4), shunt malfunction (n = 4), and wound infections (n = 3). All patients with complications required additional operations for shunt revision and/or replacement; four patients required multiple takebacks for such procedures, with an average of three additional procedures per patient.

Conclusions

In complex or syndromic craniosynostosis patients who have previously undergone ventricular shunting, PVDO is associated with higher shunt-related complications and need for additional procedures when compared to traditional PVR. While the benefits of PVDO in the treatment of syndromic craniosynostosis are well documented, the risks of PVDO in the face of a VP shunt must be considered. Further investigation into patient-specific risk factors and risk reduction strategies is warranted.

Keywords

Shunt-dependent hydrocephalus Posterior vault distraction osteogenesis Posterior vault reconstruction 

Notes

Compliance with ethical standards

Conflict of interest

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

References

  1. 1.
    Buchanan EP, Xue AS, Hollier LH (2014) Craniofacial syndromes. Plast Reconstr Surg 134(1):128e–153e.  https://doi.org/10.1097/PRS.0000000000000308 CrossRefPubMedGoogle Scholar
  2. 2.
    Panchal J, Uttchin V (2003) Management of craniosynostosis. Plast Reconstr Surg 111(6):2032–2048; quiz 2049.  https://doi.org/10.1097/01.PRS.0000056839.94034.47 CrossRefPubMedGoogle Scholar
  3. 3.
    Morris L (2016) Management of craniosynostosis. Facial Plast Surg 32(2):123–132.  https://doi.org/10.1055/s-0036-1582228 CrossRefPubMedGoogle Scholar
  4. 4.
    David LR, Proffer P, Hurst WJ, Glazier S, Argenta LC (2004) Spring-mediated cranial reshaping for craniosynostosis. J Craniofac Surg. 15(5):810–818CrossRefGoogle Scholar
  5. 5.
    Wong GB, Kakulis EG, Mulliken JB (2000) Analysis of fronto-orbital advancement for Apert, Crouzon, Pfeiffer, and Saethre-Chotzen syndromes. Plast Reconstr Surg 105(7):2314–2323CrossRefGoogle Scholar
  6. 6.
    Mackenzie KA, Davis C, Yang A (2009) R MM. Evolution of surgery for sagittal synostosis: the role of new technologies. J Craniofac Surg. 20(1):129–133.  https://doi.org/10.1097/SCS.0b013e318190e1cf CrossRefPubMedGoogle Scholar
  7. 7.
    White N, Evans M, Dover MS, Noons P, Solanki G, Nishikawa H (2009) Posterior calvarial vault expansion using distraction osteogenesis. Childs Nerv Syst 25(2):231–236.  https://doi.org/10.1007/s00381-008-0758-6 CrossRefPubMedGoogle Scholar
  8. 8.
    Renier D, Lajeunie E, Arnaud E, Marchac D (2000) Management of craniosynostoses. Childs Nerv Syst 16(10-11):645–658.  https://doi.org/10.1007/s003810000320 CrossRefPubMedGoogle Scholar
  9. 9.
    Sgouros S, Goldin JH, Hockley AD (1996) System MJC. Posterior skull surgery in craniosynostosis. Child’s Nerv Syst Google Scholar
  10. 10.
    Choi M, Flores RL, Havlik RJ (2012) Volumetric analysis of anterior versus posterior cranial vault expansion in patients with syndromic craniosynostosis. J Craniofac Surg. 23(2):455–458CrossRefGoogle Scholar
  11. 11.
    Goodrich JT (2004) Craniofacial surgery: complications and their prevention. Semin Pediatr Neurol 11(4):288–300CrossRefGoogle Scholar
  12. 12.
    Goldstein JA, Paliga JT, Wink JD, Low DW, Bartlett SP, Taylor JA (2013) A craniometric analysis of posterior cranial vault distraction osteogenesis. Plast Reconstr Surg 131(6):1367–1375.  https://doi.org/10.1097/PRS.0b013e31828bd541 CrossRefPubMedGoogle Scholar
  13. 13.
    Derderian CA, Wink JD (2015) L MJ, Collinsworth A, Bartlett SP, Taylor JA. Volumetric changes in cranial vault expansion: comparison of fronto-orbital advancement and posterior cranial vault distraction osteogenesis. Plast Reconstr Surg 135(6):1665–1672.  https://doi.org/10.1097/PRS.0000000000001294 CrossRefPubMedGoogle Scholar
  14. 14.
    Taylor JA, Derderian CA, Bartlett SP, Fiadjoe JE, Sussman EM, Stricker PA (2012) Perioperative morbidity in posterior cranial vault expansion: distraction osteogenesis versus conventional osteotomy. Plast Reconstr Surg 129(4):1–3.  https://doi.org/10.1097/PRS.0b013e3182443164 CrossRefGoogle Scholar
  15. 15.
    Copeland AE, Hoffman CE, Tsitouras V, Jeevan DS, Ho ES, Drake JM, Forrest CR (2018) Clinical significance of venous anomalies in syndromic craniosynostosis. Plast Reconstr Surg - Glob Open 6(1):e1613.  https://doi.org/10.1097/GOX.0000000000001613 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Collmann H, Sörensen N, Krauss J, Mühling J (1988) Hydrocephalus in craniosynostosis. Childs Nerv Syst 4(5):279–285PubMedGoogle Scholar
  17. 17.
    Collmann H, Sörensen N, Krauß J (2005) Hydrocephalus in craniosynostosis: a review. Childs Nerv Syst 21(10):902–912.  https://doi.org/10.1007/s00381-004-1116-y CrossRefPubMedGoogle Scholar
  18. 18.
    Sgulò FG, Spennato P, Aliberti F, Di Martino G, Cascone D, Cinalli G (2017) Contemporary occurrence of hydrocephalus and Chiari I malformation in sagittal craniosynostosis. Case report and review of the literature. Childs Nerv Syst 33(1):187–192.  https://doi.org/10.1007/s00381-016-3189-9 CrossRefPubMedGoogle Scholar
  19. 19.
    Bhasin RR, Chen MK, Pincus DW (2007) Salvaging the “lost peritoneum” after ventriculoatrial shunt failures. Childs Nerv Syst 23(5):483–486.  https://doi.org/10.1007/s00381-006-0292-3 CrossRefPubMedGoogle Scholar
  20. 20.
    Del Bigio MR (2004) Cellular damage and prevention in childhood hydrocephalus. Brain Pathol 14(3):317–324CrossRefGoogle Scholar
  21. 21.
    Cochrane DD, Kestle JR (2003) The influence of surgical operative experience on the duration of first ventriculoperitoneal shunt function and infection. Pediatr Neurosurg 38(6):295–301.  https://doi.org/10.1159/000070413 CrossRefPubMedGoogle Scholar
  22. 22.
    Gottfried ON, Binning MJ, Sherr G, Couldwell WT (2005) Distal ventriculoperitoneal shunt failure secondary to Clostridium difficile colitis. Acta Neurochir {(Wien)} 147(3):335–338; discussion 338.  https://doi.org/10.1007/s00701-004-0444-8 CrossRefPubMedGoogle Scholar
  23. 23.
    Tamburrini G, Caldarelli M, Massimi L, Gasparini G, Pelo S, Di Rocco C (2012) Complex craniosynostoses: a review of the prominent clinical features and the related management strategies. Childs Nerv Syst 28(9):1511–1523.  https://doi.org/10.1007/s00381-012-1819-4 CrossRefPubMedGoogle Scholar
  24. 24.
    Derderian CA, Bastidas N, Bartlett SP (2012) Posterior cranial vault expansion using distraction osteogenesis. Childs Nerv Syst 28(9):1551–1556.  https://doi.org/10.1007/s00381-012-1802-0 CrossRefPubMedGoogle Scholar
  25. 25.
    Lollis SS, Mamourian AC, Vaccaro TJ, Duhaime AC (2010) Programmable CSF shunt valves: radiographic identification and interpretation. Am J Neuroradiol 31(7):1343–1346.  https://doi.org/10.3174/ajnr.A1997 CrossRefPubMedGoogle Scholar
  26. 26.
    Wiberg A, Magdum S, Richards PG, Jayamohan J, Wall SA, Johnson D. Posterior calvarial distraction in craniosynostosis—an evolving technique. J Craniomaxillofac Surg 2012;40(8):799-806. doi: https://doi.org/10.1016/j.jcms.2012.02.018 CrossRefGoogle Scholar
  27. 27.
    Thomas GP, Wall SA, Jayamohan J et al (2014) Lessons learned in posterior cranial vault distraction. J Craniofac Surg 25(5):1721–1727.  https://doi.org/10.1097/SCS.0000000000000995 CrossRefPubMedGoogle Scholar
  28. 28.
    Zhang RS, Wes AM, Naran S, Hoppe IC, Sun J, Mazzaferro D, Bartlett SP, Taylor JA (2018) Posterior vault distraction osteogenesis in nonsyndromic patients: an evaluation of indications and safety. J Craniofac Surg. 29(3):566–571.  https://doi.org/10.1097/SCS.0000000000004230 CrossRefPubMedGoogle Scholar
  29. 29.
    Greives MR, Ware BW, Tian AG, Taylor JA, Pollack IF, Losee JE (2016) Complications in posterior cranial vault distraction. Ann Plast Surg 76(2):211–215.  https://doi.org/10.1097/SAP.0000000000000518 CrossRefPubMedGoogle Scholar
  30. 30.
    Woo PY, Wong HT, Pu JK et al (2016) Primary ventriculoperitoneal shunting outcomes: a multicentre clinical audit for shunt infection and its risk factors. Hong Kong Med J 22(5):410–419.  https://doi.org/10.12809/hkmj154735 CrossRefPubMedGoogle Scholar
  31. 31.
    Prusseit J, Simon M, von der Brelie C, Heep A, Molitor E, Volz S, Simon A (2009) Epidemiology, prevention and management of ventriculoperitoneal shunt infections in children. Pediatr Neurosurg 45(5):325–336.  https://doi.org/10.1159/000257520 CrossRefPubMedGoogle Scholar
  32. 32.
    Choux M, Genitori L, Lang D, Lena G (1992) Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 77(6):875–880.  https://doi.org/10.3171/jns.1992.77.6.0875 CrossRefPubMedGoogle Scholar
  33. 33.
    McGirt MJ, Zaas A, Fuchs HE, George TM, Kaye K, Sexton DJ (2003) Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens. Clin Infect Dis 36(7):858–862.  https://doi.org/10.1086/368191 CrossRefPubMedGoogle Scholar
  34. 34.
    Erps A, Roth J, Constantini S, Liat L-G, Galia G-S (2018) Risk factors and epidemiology of pediatric ventriculoperitoneal shunt infection. Pediatr Int.  https://doi.org/10.1111/ped.13709
  35. 35.
    MJ MG, Zaas A, Fuchs HE, George TM, Kaye K, Sexton DJ (2003) Risk factors for pediatric ventriculoperitoneal shunt infection and predictors of infectious pathogens. Clin Infect.  https://doi.org/10.1086/368191 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Anthony Azzolini
    • 1
  • Katie Magoon
    • 1
  • Robin Yang
    • 1
  • Scott Bartlett
    • 1
  • Jordan Swanson
    • 1
  • Jesse Taylor
    • 1
    • 2
    Email author
  1. 1.Division of Plastic and Reconstructive SurgeryChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Perelman Center for Advanced MedicinePhiladelphiaUSA

Personalised recommendations