The effect of cerebrospinal fluid’s biochemical and cellular properties on ventriculoperitoneal shunt survival
Schlagworte:
Hydrocephalus, CSF biochemistry and cellularity, ventriculoperitoneal shunt survivalAbstract
Background: The burden of hydrocephalus in our region is huge. Ventriculoperitoneal (VP) shunting is the main mode of treatment of hydrocephalus. 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. Materials and methods: This was a prospective cohort study. Patients were recruited into the study following VP shunt surgery for hydrocephalus. 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 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 data analysis. Results: A total of 82 patients met the inclusion criteria and 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.
Literaturhinweise
Fulkerson, D. H., Vachhrajani, S., Bohnstedt, B. N. et al. Analysis of the risk of shunt failure or infection related to cerebrospinal fluid cell count, protein level, and glucose levels in low-birth-weight premature infants with post-hemorrhagic hydrocephalus, Journal of Neurosurgery: Pediatrics PED 2011;7(2), 147-151.
Joseph T. Cheatle, Alexis N. Bowder, Jonathan L. Tefft, et al Effect of Protein Concentration on the Flow of Cerebrospinal Fluid Through Shunt Tubing, Neurosurgery, Volume 77, Issue 6, December 2015, Pages 972–978.
Brydon HL, Keir G, Thompson EJ. Protein adsorption to hydrocephalus shunt catheters: CSF protein adsorption Journal of Neurology, Neurosurgery & Psychiatry1998;64:643-647.
Zwimpfer, T.J., Zwimpfer, M.J. Assessment of ventriculoperitoneal (VP) shunt malfunction in an in vitro model of artificial CSF flow: influence of CSF protein concentration, CSF contamination and time of shunt incubation. Fluids Barriers CNS 12, P60 (2015) doi:10.1186/2045-8118-12-S1-P60
Kamat, A S. “CSF Protein Concentration Associated with Ventriculoperitoneal Shunt Obstruction in Tuberculous Meningitis.” The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union against Tuberculosis and Lung Disease, U.S. National Library of Medicine, 2018. 31. 6-8.
Kassebaum NJ, Arora M, Barber RM, Bhutta ZA, Brown J et al Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388:1603–1658, 2016
Pan P. Outcome analysis of ventriculoperitoneal shunt surgery in pediatric hydrocephalus. J Pediatr Neurosci 2018;13:176-81
Mwang'ombe NJ, Omulo T. Ventriculoperitoneal shunt surgery and shunt infections in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi. East Afr Med J. 2000 Jul;77(7):386-90. doi: 10.4314/eamj.v77i7.46684. PMID: 12862159.
Gichuhi K.M. Complications of ventriculo-peritoneal shunts in management of congenital and acquired hydrocephalus as seen at Kenyatta National Hospital. University of Nairobi e-repository, 1989.
Kitunguu P.K ventriculoperitoneal shunt survival at the Kenyatta national hospital; a registry based assessment; 2017. University of Nairobi repository.
Nurhayat Yakut, Ahmet Soysal, Eda Kepenekli Kadayifci et al. Persistant High Cerebrospinal Fluid Protein May Be a Risk Factor for Ventriculoperitoneal Shunt Reinfection in Children, Open Forum Infectious Diseases, Volume 3, Issue suppl_1, December 2016, 1195.
Warf BC. Hydrocephalus in Uganda: the predominance of infectious origin and primary management with endoscopic third ventriculostomy. J Neurosurg. 2005 Jan;102(1 Suppl):1-15. doi: 10.3171/ped.2005.102.1.0001. PMID: 16206728.
Anderson, I. A., Saukila, L. F., Robins, J. M. W. et al (2018). Factors associated with 30-day ventriculoperitoneal shunt failure in pediatric and adult patients, Journal of Neurosurgery JNS, 130(1), 145-153
Ambekar, Sudheer, Dwarakanath et al. Does CSF composition predict shunt malfunction in tuberculous meningitis?. The Indian journal of tuberculosis, 2011. 58. 77-81
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