Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026
Ultra-late cerebrospinal fluid shunt malfunction following an extended interval of regular follow-up: a case series.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Suzuki Hime, Sasao Asuka, Sakashita Kyoya, Horita Yoshifumi, Okuda Koji, Mikami Takeshi
Аннотация
PURPOSE: Cerebrospinal Fluid (CSF) shunt placement during infancy remains the standard treatment for pediatric hydrocephalus. However, ultra-late shunt malfunction after an extended interval of regular follow-up is poorly characterized. This study describes the clinical features, presumed pathophysiology, and management of CSF shunt dysfunction occurring decades after extended intervals without regular follow-up.
METHODS: We retrospectively evaluated patients treated for shunt malfunction at our institution between 2007 and 2025. Inclusion criteria included infant CSF shunt placement during infancy, an extended interval of regular neurosurgical follow-up, prior to malfunction, and post-adolescent shunt dysfunction. Patient demographics, underlying diseases, shunt history, clinical presentation, presumed causes, treatment, and outcomes were extracted. Cognitive development was classified as none, mild, moderate, or severe.
RESULTS: Seven patients (median age 24 years; range 21-52 years; four males, three females) met the inclusion criteria. All experienced distal catheter-related complications including obstruction (n = 5) and fracture (n = 2). Among obstructions, four indicated infection-related pathology; one patient developed a large intra-abdominal pseudocyst. Five patients presented with intracranial hypertension; two had fever or localized abdominal/subcutaneous swelling without ventriculomegaly. All underwent initial external drainage followed by shunt revision or conversion. Recurrent distal obstruction occurred in three females with peritoneal inflammation. Four patients had mild-to-severe cognitive impairment; three were independent.
CONCLUSION: Ultra-late CSF shunt dysfunction may occur decades after extended intervals of regular follow-up, primarily due to distal catheter obstruction and infection-related pathology. Symptoms may be atypical, and recurrence is common in cases with peritoneal inflammation. These findings emphasize the importance of lifelong surveillance and heightened clinical vigilance for patients with a history of pediatric CSF shunt placement.
METHODS: We retrospectively evaluated patients treated for shunt malfunction at our institution between 2007 and 2025. Inclusion criteria included infant CSF shunt placement during infancy, an extended interval of regular neurosurgical follow-up, prior to malfunction, and post-adolescent shunt dysfunction. Patient demographics, underlying diseases, shunt history, clinical presentation, presumed causes, treatment, and outcomes were extracted. Cognitive development was classified as none, mild, moderate, or severe.
RESULTS: Seven patients (median age 24 years; range 21-52 years; four males, three females) met the inclusion criteria. All experienced distal catheter-related complications including obstruction (n = 5) and fracture (n = 2). Among obstructions, four indicated infection-related pathology; one patient developed a large intra-abdominal pseudocyst. Five patients presented with intracranial hypertension; two had fever or localized abdominal/subcutaneous swelling without ventriculomegaly. All underwent initial external drainage followed by shunt revision or conversion. Recurrent distal obstruction occurred in three females with peritoneal inflammation. Four patients had mild-to-severe cognitive impairment; three were independent.
CONCLUSION: Ultra-late CSF shunt dysfunction may occur decades after extended intervals of regular follow-up, primarily due to distal catheter obstruction and infection-related pathology. Symptoms may be atypical, and recurrence is common in cases with peritoneal inflammation. These findings emphasize the importance of lifelong surveillance and heightened clinical vigilance for patients with a history of pediatric CSF shunt placement.