Complicaciones quirúrgicas de la derivación ventrículo-peritoneal en niños y adolescentes hidrocefálicos

Tania Leyva Mastrapa, Luis Alonso Fernández, Manuel Díaz Álvarez, Maricela Morera Pérez, Irene Barrios Osuna

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Resumen

Objetivo: Describir las complicaciones graves, leves y específicas de los niños tratados por hidrocefalia mediante derivación ventrículo-peritoneal.

Métodos: Se realizó un estudio descriptivo de niños y adolescentes hasta 18 años, de ambos sexos, ingresados con diagnóstico de hidrocefalia en el Hospital Pediátrico Docente “Juan Manuel Márquez”, de enero de 2004 a diciembre de 2007. El universo fue de 538 pacientes; y la muestra, de 112, quienes tuvieron seguimiento hasta diciembre 2017. Las variables utilizadas fueron: edad, sexo, color de la piel, tiempo de seguimiento de los pacientes, causas de la hidrocefalia, sistemas derivativos utilizados, tiempo quirúrgico y las complicaciones quirúrgicas. Los resultados se presentaron resumidos en frecuencias absolutas y porcentajes.

Resultados: Predominó el sexo masculino y la edad media menor de un año. Las causas más frecuentes fueron la tumoral y la secundaria a hemorragia intraventricular. Las derivaciones ventrículo-peritoneales más utilizadas fueron las válvulas de diferencia de presión (60,7%), con un índice de fallo de 66,1 %. La media del tiempo quirúrgico fue significativamente mayor en los niños que presentaron infección de la derivación ventrículo-peritoneal (56,8 minutos vs 45,5 minutos en los que no ocurrió). Presentaron en su evolución más de una complicación 75 % de los pacientes; 33 % tuvieron complicaciones graves y 64,2 % leves. Las complicaciones específicas de las derivaciones ventrículo-peritoneal, más frecuentes, fueron las mecánicas (61 %), seguidas de las neurológicas (48,2 %), y las abdominales representaron 14,7 %.

Conclusiones: La mayoría de los niños presentaron complicaciones leves (62,1 %); las mecánicas fueron las más frecuentes, seguidas de las neurológicas y las infecciosas. El índice de sepsis de la derivación ventrículo-peritoneal en nuestro estudio fue mayor al alcanzado en otros estudios internacionales, dado por una causalidad multifactorial.

Palabras clave

derivación ventrículo peritoneal; complicaciones; niños; obstrucción mecánica; índice de sepsis; epilepsia; absceso cerebral

Referencias

Aschoff A, Kremer P, Hashemi B, Kunze S. The scientific history of hydrocephalus and its treatment. Neurosurgical Review. 1999;22(2-3):67-93.

Gupta N, Park J, Solomon C, Kranz DA, Wrensch M, Wu YW. Long-term outcomes in patients with treated childhood hydrocephalus. J Neurosurg. 2007;106(5 Suppl):334-9.

Gmeiner M, Wagner H, van Ouwerkerk WJR, Sardi G, Thomae W, Senker W, et al. Long-Term Outcomes in Ventriculoatrial Shunt Surgery in Patients with Pediatric Hydrocephalus: Retrospective Single-Center Study. World Neurosurgery. 2020;138:e112-e8.

Lee L, Low S, Low D, Ng LP, Nolan C, Seow WT. Late pediatric ventriculoperitoneal shunt failures: a Singapore tertiary institution's experience. Neurosurgical Focus. 2016;41(5):E7.

Simon TD, Riva-Cambrin J, Srivastava R, Bratton SL, Dean JM, Kestle JR. Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths. J Neurosurg Pediatr. 2008;1(2):131-7.

Di Rocco C, Massimi L, Tamburrini G. Shunts vs endoscopic third ventriculostomy in infants: are there different types and/or rates of complications? A review. Childs Nerv Syst. 2006;22(12):1573-89.

Vinchon M, Rekate H, Kulkarni AV. Pediatric hydrocephalus outcomes: a review. Fluids and barriers of the CNS. 2012;9:18.

Riva-Cambrin J, Kestle JRW, Holubkov R, Butler J, Kulkarni AV, Drake J, et al. Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study. J Neurosurg Pediatr. 2016;17(4):382-90. Doi: 10.3171/2015.6.PEDS14670

Yakut N, Soysal A, Kepenekli Kadayifci E, Dalgic N, Yılmaz Ciftdogan D, Karaaslan A, et al. Ventriculoperitoneal shunt infections and re-infections in children: a multicentre retrospective study. British Journal of Neurosurgery. 2018;32(2):196-200.

Hasanain AA, Abdullah A, Alsawy MFM, Soliman MAR, Ghaleb AA, Elwy R, et al. Incidence of and Causes for Ventriculoperitoneal Shunt Failure in Children Younger Than 2 Years: A Systematic Review. J Neurol Surg Rep. Part A, Central European Neurosurgery. 2019;80(1):26-33.

Chen S, Peng J, Deng X, Wu L, Xiong J, Duan H, et al. Application of ventricular shunt for children with post-infective hydrocephalus. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2019 Nov 28;44(11):1230-7.

Lekic T, Klebe D, Poblete R, Krafft PR, Rolland WB, Tang J, et al. Neonatal Brain Hemorrhage (NBH) of Prematurity: Translational Mechanisms of the Vascular-Neural Network. Current Medicinal Chemistry. 2015;22(10):1214-38.

Wellons JC, Shannon CN, Holubkov R, Riva-Cambrin J, Kulkarni AV, Limbrick DD Jr, et al; Hydrocephalus Clinical Research Network. Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study. J Neurosurg Pediatr. 2017 Jul;20(1):19-29.

Ahmadvand S, Dayyani M, Etemadrezaie H, Ghorbanpour A, Zarei R, Shahriyari A, et al. Rate and Risk Factors of Early Ventriculoperitoneal Shunt Revision: A Five-Year Retrospective Analysis of a Referral Center. World Neurosurgery. 2020;134:e505-e11.

Vlasak A, Okechi H, Horinek D, Albright AL. Pediatric Ventriculoperitoneal Shunts Revision Rate and Costs in High-Volume sub-Saharan Department. World Neurosurgery. 2019;130:e1000-e3.

Ved R, Bentley E, Amato-Watkins A, Lang J, Zilani G, Bhatti I, et al. One year failure rates for de-novo ventriculo-peritoneal shunts in under 3-month-old children. British Journal of Neurosurgery. 2019;33(3):357-9.

Koide Y, Osako T, Kameda M, Ihoriya H, Yamamoto H, Fujisaki N, et al. Huge abdominal cerebrospinal fluid pseudocyst following ventriculoperitoneal shunt: a case report. Journal of Medical Case Reports. 2019;13(1):361.

Garegnani L, Franco JV, Ciapponi A, Garrote V, Vietto V, Portillo Medina SA. Ventriculo-peritoneal shunting devices for hydrocephalus. The Cochrane Database of Systematic Reviews. 2020;6(6):Cd012726.

Preuss M, Kutscher A, Wachowiak R, Merkenschlager A, Bernhard MK, Reiss-Zimmermann, et al. Adult long-term outcome of patients after congenital hydrocephalus shunt therapy. Childs Nerv Syst. 2015;31:49-56. Doi: 10.1007/s00381-014-2571-8.

Gonzalez DO, Mahida JB, Asti L, Ambeba EJ, Kenney B, Governale L, et al. Predictors of Ventriculoperitoneal Shunt Failure in Children Undergoing Initial Placement or Revision. Pediatric Neurosurgery. 2017;52(1):6-12.

Di Rocco C, Marchese E, Velardi F. A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus. Cooperative survey of the 1991-1992 Education Committee of the ISPN. Childs Nerv Syst. 1994;10(5):321-7.

Keene DL, Ventureyra EC. Hydrocephalus and epileptic seizures. Childs Nerv Syst.1999;15(4):158-62.

Neiter E, Guarneri C, Pretat PH, Joud A, Marchal JC, Klein O. Semiology of ventriculoperitoneal shunting dysfunction in children - a review. Neuro-Chirurgie French. 2016;62(1):53-9.

Burhan B, Serdar KB, Abdurrahman A, Edip AM, Ebuzer D. Abdominal Complications of Ventriculoperitoneal Shunt in Pediatric Patients: Experiences of a Pediatric Surgery Clinic. World Neurosurgery. 2018;118:e129-e36.

Masoudi MS, Rasafian M, Naghmehsanj Z, Ghaffarpasand F. Intraperitoneal cerebrospinal fluid pseudocyst with ventriculoperitoneal shunt. African Journal of Paediatric Surgery. 2017;14(3):56-8.

Baird LC, Mazzola CA, Auguste KI, Klimo P Jr., Flannery AM. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 5: Effect of valve type on cerebrospinal fluid shunt efficacy. J Neurosurg Pediatr. 2014;14 (Suppl 1):35-43.

Freimann FB, Luhdo M-L, Rohde V, Vajkoczy P, Wolf S, Sprung C. The Frankfurt horizontal plane as a reference for the implantation of gravitational units: a series of 376 adult patients. Acta Neurochirurgica. 2014;156(7):1351-6.

Nikas DC, Post AF, Choudhri AF, Mazzola CA, Mitchell L, Flannery AM. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 10: Change in ventricle size as a measurement of effective treatment of hydrocephalus. J Neurosurg Pediatr. 2014;14(Suppl 1):77-81.

Raybaud C. MR assessment of pediatric hydrocephalus: a road map. Childs Nerv Syst. 2015;32(1):19-41.

Simon TD, Butler J, Whitlock KB, Browd SR, Holubkov R, Kestle JR, et al. Risk factors for first cerebrospinal fluid shunt infection: findings from a multi-center prospective cohort study. The Journal of Pediatrics. 2014;164(6):1462-8.e2. Doi: 10.1016/j.jpeds.2014.02.013

Piatt JH. Thirty-day outcomes of cerebrospinal fluid shunt surgery: data from the National Surgical Quality Improvement Program-Pediatrics. J Neurosurg Pediatr. 2014;14(2):179-83.

Xu H, Hu F, Hu H, Sun W, Jiao W, Li R, et al. Antibiotic prophylaxis for shunt surgery of children: a systematic review. Childs Nerv Syst. 2015;32(2):253-8.

Klimo P Jr., Thompson CJ, Baird LC, Flannery AM. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 7: Antibiotic-impregnated shunt systems versus conventional shunts in children: a systematic review and meta-analysis. J Neurosurg Pediatr. 2014;14 (Suppl 1):53-9.

Kumar V, Shah AS, Singh D, Loomba PS, Singh H, Jagetia A. Ventriculoperitoneal shunt tube infection and changing pattern of antibiotic sensitivity in neurosurgery practice: Alarming trends. Neurology India. 2016;64(4):671-6.

Wu X, Liu Q, Jiang X, Zhang T. Prevention options for ventriculoperitoneal shunt infections: a retrospective analysis during a five-year period. International Journal of Clinical and Experimental Medicine. 2015;8(10):19775-80.

Jenkinson MD, Gamble C, Hartley JC, Hickey H, Hughes D, Blundell M, et al. The British antibiotic and silver-impregnated catheters for ventriculoperitoneal shunts multi-centre randomised controlled trial (the BASICS trial): study protocol. Trials. 2014;15:4. Doi: 10.1186/1745-6215-15-4

James G, Hartley JC, Morgan RD, Ternier J. Effect of introduction of antibiotic-impregnated shunt catheters on cerebrospinal fluid shunt infection in children: a large single-center retrospective study. J Neurosurg Pediatr. 2014;13:101-6. Doi: 10.3171/2013.10.PEDS13189

Beckman JM, Amankwah EK, Tetreault LL, Tuite GF. Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure. J Neurosurg Pediatr. 2015;16(6):648-61.

Sarmey N, Kshettry VR, Shriver MF, Habboub G, Machado AG, Weil RJ. Evidence-based interventions to reduce shunt infections: a systematic review. Childs Nerv Syst. 2015;31(4):541-9.

Adams DJ, Rajnik M. Microbiology and Treatment of Cerebrospinal Fluid Shunt Infections in Children. Current Infectious Disease Reports. 2014;16(10):1-9.

Parker SL, McGirt MJ, Murphy JA, Megerian JT, Stout M, Engelhart L. Comparative effectiveness of antibiotic-impregnated shunt catheters in the treatment of adult and pediatric hydrocephalus: analysis of 12,589 consecutive cases from 287 US hospital systems. J Neurosurg. 2015;122:443-8. Doi: 10.3171/2014.10.JNS13395.

Attenello FJ, Garces-Ambrossi GL, Zaidi HA, Sciubba DM, Jallo GI. Hospital costs associated with shunt infections in patients receiving antibiotic-impregnated shunt catheters versus standard shunt catheters. Neurosurgery. 2010;66(2):284-9.

Simon TD, Whitlock KB, Riva-Cambrin J, Kestle JR, Rosenfeld M, Dean JM, et al. Revision surgeries are associated with significant increased risk of subsequent cerebrospinal fluid shunt infection. The Pediatric Infectious Disease Journal. 2012;31(6):551-6.

Simon TD, Whitlock KB, Riva-Cambrin J, Kestle JR, Rosenfeld M, Dean JM, et al. Association of intraventricular hemorrhage secondary to prematurity with cerebrospinal fluid shunt surgery in the first year following initial shunt placement. Journal of Neurosurgery Pediatrics. 2012;9(1):54-63.

Van Lindert EJ, Delye H, Leonardo J. Prospective review of a single center’s general pediatric neurosurgical intraoperative and postoperative complication rates. J Neurosurg Pediatr. 2014;13:107-13.

Díaz Álvarez M, Vivas González M, Arango Arias M, Leyva Mastrapa T, Alonso Fernández L. Infección de la derivación ventrículo-peritoneal en recién nacidos con Hidrocefalia. Rev Cubana Pediatr. 2008;80:3.

Kestle JR, Holubkov R, Cochrane D, Kulkarni AV, Limbrick Jr DD, Luerssen TG, et al. A new Hydrocephalus Clinical Research Network protocol to reduce cerebrospinal fluid shunt infection. J Neurosurg Pediatr. 2016;17:391-6. Doi: 10.3171/2015.8.PEDS15253





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