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Infective Complications

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Complications of CSF Shunting in Hydrocephalus

Abstract

Shunt infections remain a serious problem in treating hydrocephalus. An average of 7 % of all shunting procedures and 10 % of all patients with a shunt device are complicated by infection despite the numerous preventive measures used to decrease the risk of infection of the CSF or the shunt device. Classically, we distinguish early from late infection with the highest incidence observed during the first 2 months after the placement of the shunt. The clinical presentation can vary greatly depending on the site of infection and the age of the patient. Nonspecific symptoms of infection can occur; however, many cases will present as shunt malfunctions. A high index of suspicion and proximity to a recent shunt manipulation makes this infective complication more likely. CSF cultures are the most definitive method of diagnosis, although other laboratory values and imaging studies may point to an infection. The bacteria responsible for most shunt infections are commensal organisms with low virulence, especially coagulase-negative staphylococci. Treatment usually involves the removal of the infected shunt and placement of a temporary external ventricular drainage. Appropriate intravenous antibiotics are started based on CSF culture and bacteria sensitivity results. A new shunt system is installed when the infection has been eradicated. Several other treatment strategies exist. If treated promptly and vigorously, shunt infections usually resolve without sequelae. However, if neglected, infective complications remain a significant cause of morbidity and death.

This chapter analyzes the risk factors, identification, management, and prevention of shunt infections based on international experience.

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Abbreviations

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

CT-scan:

Computed tomography scan

MRI:

Magnetic resonance imaging

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Avicenne Military Hospital of Marrakech, University of Mohammed V Souissi, Rabat, 10100, Morocco

    Ali Akhaddar MD

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  1. Ali Akhaddar MD
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Correspondence to Ali Akhaddar MD .

Editor information

Editors and Affiliations

  1. Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy

    Concezio Di Rocco

  2. Department of Neurosurgery, Adnan Menderes University School of Medi, Aydin, Turkey

    Mehmet Turgut

  3. Division of Pediatric Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA

    George Jallo

  4. Regional Service of Neurosurgery and Unit of Pediatric Neurosurgery, Virgen de la Arrixaca University Hospital, Murcia, Spain

    Juan F. Martínez-Lage

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Akhaddar, A. (2015). Infective Complications. In: Di Rocco, C., Turgut, M., Jallo, G., Martínez-Lage, J. (eds) Complications of CSF Shunting in Hydrocephalus. Springer, Cham. https://doi.org/10.1007/978-3-319-09961-3_9

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  • DOI: https://doi.org/10.1007/978-3-319-09961-3_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09960-6

  • Online ISBN: 978-3-319-09961-3

  • eBook Packages: MedicineMedicine (R0)

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