EFFECT ON SHUNT SURVIVAL OF THE BIOCHEMICAL & CELLULAR PROPERTIES OF CEREBROSPINAL FLUID AMONG PATIENTS FOLLOWING VENTRICULOPERITONEAL SHUNTING

Abstract

Study background: The burden of hydrocephalus in our region is huge. It is estimated that 6000 new cases are diagnosed in Kenya, most of which undergo ventriculoperitoneal shunting. These shunts frequently malfunction, with shunt blockage being the commonest cause of shunt failure. The biochemical and cellular properties of CSF are hypothesized to contribute to shunt blockage. This study aimed to demonstrate the impact of these CSF properties on shunt survival. Study design and site: Prospective cohort study. This study was carried out in Kenyatta National Hospital within the neurosurgical, pediatric and the medical wards. Participants and Methods: Patients were recruited into the study following VP shunt surgery for hydrocephalus. Data collected at recruitment included study identification, age, sex, residence and etiology of hydrocephalus. Additionally, data regarding the CSF biochemistry including proteins and glucose and cellularity was also abstracted from the patient files. Based on their baseline CSF biochemical and cellular properties, the patients were divided into two groups; those with normal and those with abnormal CSF biochemistry and cellularity. Patients were then be followed up in the neurosurgical clinics for a period of 3months during which shunt function was assessed clinically.This data was then entered to the statistical package for social sciences (IBM SPSS statistics 25.0) for univariate and multivariate analysis.Survival analysis using Kaplan Meir was used to assess for time to shunt failure. Results:82 patients were recruited into the study. Forty-six (56.1%) were male while 36(43.9%) of them were female. The mean age was 15.5 months (SD 23.4 months). Majority (82.9%) of the patients had congenital hydrocephalus with Dandy walker malformation being the most common congenital anomaly seen. Most patients (52.44%) had normal CSF proteins while the remainder had elevated CSF proteins. Majority of the patients had reduced levels of CSF glucose at 65.9%. The CSF cell count was normal for most of the patients at 86.6%. Elevated CSF protein concentration was associated with an increased likelihood of ventriculoperitoneal shunt failure by 8.7 times compared to the patients with normal CSF protein concentration. Reduced CSF glucose concentration was associated was also found to increase the likelihood of shunt failure in this study. There was no correlation between the CSF cell count and the likelihood of shunt failure. Conclusion: Congenital anomalies were the commonest cause of hydrocephalus in this study. Almost half of the patients treated with hydrocephalus during the study period had elevated CSF proteins. Elevated CSF proteins increased the probability of shunt failure at 3 months of follow up. A positive correlation was also seen with reduced CSF glucose and the likelihood of shunt failure. CSF cell count did not affect shunt function in this study.