Article
Valve occlusion in CSF shunts therapy – does protein and cell count in CSF matter?
Shunt occlusion in der Hydrocephalus-Therapie – Welche Rolle spielen Protein-Gehalt und Zellzahl im Liquor?
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Authors
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Stefanie Kaestner
- Klinikum Kassel, Niestetal, Deutschland
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Rebekka Sani
- University of Southampton, Kassel School of Medicine, Southampton, Vereinigtes Königreich
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Katharina Graf
- University of Gießen, Neurosurgery, Gießen, Deutschland
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Eberhard Uhl
- University of Gießen, Neurosurgery, Gießen, Deutschland
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Wolfgang Deinsberger
- Klinikum Kassel, Niestetal, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Shunt obstruction os a common cause of shunt failure in the treatment of hydrocephalus. Especially valve occlusion is traditionally believed to originate from elevated protein values or cell components in the CSF but detailed information is conflicting. The aim of this study was to explore the risk of shunt obstruction with regard to the levels of protein and cell counts in the CSF.
Methods: 274 patients who recieved shunt treatment between 2011 until 2018 with a follow up of at least one year were retrospectively explored for shunt malfunction due to valve obstruction. Age, the origin of hydrocephalus, the valve type, protein values and cell count in CSF at the time of shunt insertion and revision surgery were analysed.
Results: 32 fo 274 patients needed revision surgery due to valve obstruction (11.7%) at a mean time interval of 143 days. WBC count in CSF but not protein in CSF were associated with overall valve obstruction. 25% of all obstructed valves showed protein values within the normal range, whereas 13.6% of all patients showed vastly elevated protein levels in CSF without evidence for valve obstruction. Seperating between early (<90 days) and late (>90 days) valve obstruction, a persisting elevated protein content in CSF at the time of shunt revision is significantly associated with early valve obstruction. Children with congenital and posthaemorrhagic patients are significantly overrepresented in the occlusion group especially in the early occlusion group.
Conclusion: Pathological CSF values such as WBC count and persisting elevated levels in CSF serve as a risk factor for ealry valve obstruction. Late obstruction occurs irrespective of normal CSF values. Especially infants are prone to early and late valve obstructions. The simple protein content in CSF at shunt insertion is not predictable for valve occlusions.
