217. Shifting Perceptions of a Biased Curve: Ventricular Shunts

Authors: Jeffrey P. Blount, MD, FAAP, FAANS; Jeffrey Blount, MD; Betsy Hopson; Isaac Shamblin; Brandon Rocque, MD (Birmingham, AL)

Introduction:

Controversy surrounds the natural history of an implanted ventricular shunt. Patients with complex and difficult shunts are disproportionately represented in the exposure of pediatric neurosurgeons which has the potential to foster negative bias toward the natural history of implanted shunts. To address this we sought to quantify the extent of our spina bifida shunt cohort that demonstrated zero or limited shunt revisions throughout their natural life.

Methods:

A retrospective chart review was performed for patients between ages 10-21 with a primary diagnosis of myelomeningocele and having received an initial hydrocephalus treatment of a ventricular shunt.

Results:

Final sample of patients born with myelomeningocele (n=156) was 54% male, 79% Caucasian, 8% Hispanic, and 29% had a mid-lumber functional level of lesion. Each patient received an initial treatment with a shunt with 487 additional shunt procedures evaluated.
Of the sample, 15% never needed an additional shunt surgery, 46% received less than or equal to two surgeries, 25% received between three-to-six surgeries, and only 13% of patients received greater than six additional surgeries.
The patients needing greater than six additional procedures encompass 47% of the total surgeries performed after the initial shunt placement (n=487) with a lower and higher limit of 7 and 33 respectively.

Conclusion:

More than 60% of shunted patients in this cohort had 2 or fewer shunt revisions throughout their entire lifespan. 15% never required revision. These are important considerations in evaluating treatment options for patients with hydrocephalus.