Complications Related to the Treatment of Hydrocephalus with Extrathecal Cerebrospinal  Fluid Shunts

Abstract

Cerebrospinal fluid (CSF) extrathecal shunts continue to be the standard treatment of hydrocephalus in children (Drake et al. 1998). Procedures for CSF shunting and revision of implanted CSF shunt devices accounted for 69,000 annual hospital admissions and 36,000 surgical procedures with a cost of 1 billion/year at the end of the last century (Bondurant and Jimenez 1995); the current figures are even greater (Patwardhan and Nanda 2005; Simon et al. 2008). Hydrocephalus, indeed, remains one of the disease most commonly treated in a service of pediatric neurosurgery and the complications of its treatment are the cause of major concern for the pediatric neurosurgeon in spite of the current major utilization of internal CSF shunts (Beuriat et al. 2017). Actually, CSF shunting complications increase the number of anesthesiological and surgical procedures besides being a possible cause of induced severe associated pathological conditions occasionally leading to death. Indeed, a large variety of complications of extrathecal CSF shunt is encountered in the clinical practice, ranging from failures of the initial surgical procedure for implanting the CSF shunting and the technical limitations of the implanted CSF shunting device to reactions of the body to the presence of the devices or inability to reabsorb the diverted CSF. Approximately, 41% of all shunting procedures performed in a pediatric neurosurgical service are due to malfunction of the CSF shunting device while 7–13% are related to infectious complications secondary to the surgical procedure for the insertion of the CSF shunting apparatus or its mere presence in the body (Patwardhan and Nanda 2005; Berry et al. 2008).