Rate of shunt revision as a function of age in patients with shunted hydrocephalus due to myelomeningocele.
Rate of shunt revision as a function of age in patients with shunted hydrocephalus due to myelomeningocele.
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DOI：
10.3171/2016.8.focus16257
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发表时间：
2016-11
影响因子：
4.1
通讯作者：
Rocque BG
中科院分区：
文献类型：
--
作者：
Dupepe EB;Hopson B;Johnston JM;Rozzelle CJ;Jerry Oakes W;Blount JP;Rocque BG
一般认为，脑脊液分流术在生命的最初几年最常失败。本研究的目的是描述在一个明确定义的队列中，由于脊髓脊膜膨出（MMC）导致分流脑积水的给定患者年龄的分流失败风险。作者分析了他们机构脊柱裂研究数据库的数据，包括所有MMC和分流脑积水患者。对于整个人群，确定每个生命年的分流翻修次数。然后计算生命中每一年存在分流翻修风险的患者数量，从而使他们能够计算每名患者生命中每一年的分流翻修率。通过这种方式，计算了整个诊所人群的所有分流翻修手术的时间以及在生命的每一年内进行分流翻修的可能性。脊柱裂研究数据库共招募了655名患者，其中519名被诊断为MMC，平均年龄为17.48 ± 11.7岁（中位年龄16岁，范围0-63岁）。417例患者接受了CSF分流术治疗脑积水，因此被纳入本分析。出生后第一年有94例分流系统翻修，这代表该年每例患者的翻修率为0.23。除了青少年早期的翻修频率增加外，每患者年的分流翻修率最初随年龄增加而降低。直到43岁时仍继续发生分流翻修。这些数据证实了MMC患者的分流翻修手术在出生后第一年最常见，此后减少，但在青少年早期增加。在成年期观察到分流失败的持续风险。这些发现强调了对所有分流性脑积水的MMC患者进行常规随访的重要性，并将有助于咨询患者和家属。
It is generally accepted that cerebrospinal fluid shunts fail most frequently in the first years of life. The purpose of this study was to describe the risk of shunt failure for a given patient age in a well-defined cohort with shunted hydrocephalus due to myelomeningocele (MMC). The authors analyzed data from their institutional spina bifida research database including all patients with MMC and shunted hydrocephalus. For the entire population, the number of shunt revisions in each year of life was determined. Then the number of patients at risk for shunt revision during each year of life was calculated, thus enabling them to calculate the rate of shunt revision per patient in each year of life. In this way, the timing of all shunt revision operations for the entire clinic population and the likelihood of having a shunt revision during each year of life were calculated. A total of 655 patients were enrolled in the spina bifida research database, 519 of whom had a diagnosis of MMC and whose mean age was 17.48 ± 11.7 years (median 16 years, range 0–63 years). Four hundred seventeen patients had had a CSF shunt for the treatment of hydrocephalus and thus are included in this analysis. There were 94 shunt revisions in the first year of life, which represents a rate of 0.23 revisions per patient in that year. The rate of shunt revision per patient-year initially decreased as age increased, except for an increase in revision frequency in the early teen years. Shunt revisions continued to occur as late as 43 years of age. These data substantiate the idea that shunt revision surgeries in patients with MMC are most common in the first year of life and decrease thereafter, except for an increase in the early teen years. A persistent risk of shunt failure was observed well into adult life. These findings underscore the importance of routine follow-up of all MMC patients with shunted hydrocephalus and will aid in counseling patients and families.