Shunt Infection


Introduction

Cerebrospinal Fluid Production and Absorption 

Cerebrospinal Fluid Volume and Composition 

Etiology and Pathophysiology of Hydrocephalus

Post-hemorrhagic Hydrocephalus 

Hydrocephalus and Myelomeningocele 

Aqueduct Stenosis 

Dandy Walker Syndrome 

Obstructive Hydrocephalus Due to Tumors 

Post-meningitic Hydrocephalus 

Hydrocephalus and Venous Hypertension 

Hydrocephalus Following Subarachnoid Hemorrhage 

Normal Pressure Hydrocephalus 

Idiopathic Intracranial Hypertension 

Arrested Hydrocephalus 

Hydrocephalus Versus Ventriculomegaly 

 Clinical Presentation of Hydrocephalus 

Investigation of Hydrocephalus 

Treatment of Hydrocephalus 

Medical Treatment 

Complications of Shunts

  1. The Presentation of Shunt Infection 
  2. Organisms Responsible for Shunt Infection 
  3. Treatment of Shunt Infection 
  4. The Role of Antibiotic Prophylaxis in Shunt Surgery 

Miscellaneous Shunt Complications 

The Prognosis of Shunted Hydrocephalus 

Shunt infection is one of the most common complications encountered and one that carries significant morbidity and even mortality. Shunt infections result in prolonged hospitalization, they increase the risk of subsequent shunt malfunction and can lead to physical disability and impaired intellectual development. Reported shunt infection rates in some instances exceed 20%, although a range of 5-15% would be a more realistic figure, examining larger series of pediatric patients. Rates as low as 1% have been achieved in some centers [17].

The subject of shunt infection is a complex one, and beyond the differences between individual neurosurgical units, there are important variations relating to the heterogeneity of the hydrocephalic population. Whilst shunt infection may afflict adults as well as children, it is in the pediatric population that shunt infection rates tend to be greater and the majority of studies have been performed in this group.

Although there are many factors that appear to contribute to shunt infection, it is generally assumed that contamination of the shunt system occurs at or around the time of shunt surgery. Poor surgical technique, excessive handling of the shunt hardware and inadequate operative environment are among some of the general risk factors frequently cited. Specific factors that appear to have particularly strong correlations with shunt infection are post- operative wound infection and CSF leakage; strenuous measures should be taken to avoid these complications.

Within the pediatric age group, patient age also appears to play a significant role. Pople et al. [18] report an incidence of infection of 15.7% in children less than 6 months of age in contrast to a rate of 5.6% in those older than 6 months. Immunological immaturity, different microbiological flora and physical properties of the skin are among the possible factors increasing the risk of shunt infection in the neonate.

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