Introduction: Percutaneous methods of placing of VA shunts have greatly simplified their insertion. However, no recent studies have been completed evaluating ventriculoperitoneal shunts (VPS) and percutaneously placed VA shunts (percVAS) in the pediatric population. Review of our series of percVAS over the past 13 years suggested that these patients have done better than historical controls. This led to our current study, which compares outcomes of new VPS and percVAS placed from 2000 through 2005.
Methods: Retrospective review of all new VPS and percVAS placed from 2000 through 2005 with 5+ year follow-up, analyzing age, infection rate, revision rate, and origins of failure.
Results: There were 33 new percVAS inserted, with an average of 1.88 revisions per insertion. Overall acute failure rate (discounting elective lengthening) was 60.6%, with 33.3% revised within 12 months. Average time to first revision was 25.5 months. 30.7% of revisions were elective catheter lengthening procedures. Average age at percVAS was 7.27 years. Infection rate was 6.06%.
There were 126 new VP shunts inserted, with an average of 0.86 revisions per VP placement. Overall acute failure rate was 56%, with 67.1% failing within 12 months. Average time to first revision was 15.8 months. There were 108 total revisions (42.6% proximal, 17.6% valve, 5.6% distal, and 13.9% removed because infection). Average age at VPS was 2.42 years. Total infection rate was 12%.
Conclusions: PercVAS had a lower infection rate than VPS. VPS and percVAS had comparable acute failure rates. VAS lasted on average nearly nine months longer than VPS prior to first revision. It is important to note most percVAS were placed in patients who had failed prior VP shunts, thus were inherently more complex patients. These findings suggest that percVAS should be considered as a valuable option and may warrant first-line consideration in some complex shunt patients.
Patient Care: Raises awareness of a valuable but nearly forgotten treatment option for hydrocephalus and displays evidence of very effective if not superior outcomes to traditional care.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the management options for complex shunt patients.
2) Discuss the value of percVAS in shunt dependent patients.
3) Identify effective treatments of hydrocephalus in patients with multiple VP shunt failure.