gms | German Medical Science

Objective: Despite increasing treatment options and indications of endoscopic procedures, children treated with CSF-shunts represent the majority of hydrocephalus patients in daily paediatric neurosurgical and outpatient routine. Continuous technical advancements in valve construction and catheter materials over the years lead to an exceptional variety of different shunt systems and make conclusive outcome evaluation difficult to capture. The UK shunt registry (1995-2009) exemplarily constituted one of the so far very rare efforts worldwide to evaluate outcome and revision rates in the long-term outside of randomized trials in shunt treated paediatric hydrocephalus.

Method: We developed a paediatric csf-shunt registry providing chronologically listed details about all individual implants, shunt-related surgeries and events. We retrospectively included all patients that underwent documented CSF-shunt implantation or shunt revision at the age between 0 and 17 years at our institution back to 1995 and completed surgical shunt history up to date. The shunt registry is continuously supplemented for all patients prospectively with every new shunt-related surgery or forthcoming programming shunt-procedure.

Results: In 3,451 documented neurosurgical procedures in patients younger than 18 years, we found 13% new shunt implantations, 16% shunt revisions, 20% ventricular drainages or endoscopic procedures. Up to now, 488 individual patients entered the database of the shunt registry. For all patients with at least 5 years of continuous follow-up (N=200, median follow-up150 months), revision-free shunt survival after 6 months-, 1 year and 5 years were 82%, 78% and 64% respectively. Initial shunt implantation in premature infants and babies showed significantly decreased revision-free shunt survival (p=0.0047), higher infection rates and increased number of future shunt revisions compared to children older than 12 months.

Conclusions: With the implementation of our institutional paediatric shunt registry we applied a sustainable digital up to date shunt pass that conclusively provides a systematic collection of complete individual shunt-related data in a chronological fashion at any time. The application enhances the standard of care in daily clinical routine and enables institutional quality control as well the evaluation of shunt-related morbidity and causes of shunt revisions in paediatric hydrocephalus patients.