student research day - Case Western Reserve University School of ...

Melvin E. Omodon
Quantifying Risk Factors For Shunt Malfunction In Pediatric Brain
Tumor Patients
Melvin E. Omodon, Mark D. Krieger,MD; J. Gordon McComb,MD
Neurosurgery Department
Childrens Hospital Los Angeles, Los Angeles, CA
Introduction: Complications associated with shunts placed in children with brain tumors are not well quantified.
Methods: 184 children who had brain tumors and required shunting were identified under an IRB-approved
protocol.. The average age was 72 months. The average follow-up time was 53 months. Tumor types included 50
medulloblastomas, 24 ependymomas, 70 pilocytic astrocytomas, 21 anaplastic astrocytomas, and 14
craniopharyngiomas.
Results: 31% of the shunts (56 patients) required revisions and 10% of the shunt placements (18 patients) were
complicated by infections. 42% of all malfunctions occurred within the first 6 months post shunt placement. The
rate for shunt malfunction was highest in patients with anaplastic astrocytoma (37%), and lowest in patients with
ependymomas (25%). Highest rates of shunt malfunction was associated with supratentorial tumor location (44%),
anaplastic astrocytoma histology (47%), and an age of initial shunt placement between 2-5yrs (51%). Risk factors
for distal malfunction include infratentorial location (24%). Highest rate of multiple malfunction were found in
patients between age of 2-5 yrs (38%).
Risk factors for infection included supratentorial tumor location (11% infection rate), ependymoma histology
(13%), and age of shunt placement between 6 months to 2yrs (12%).The lowest infection rate was in patients with
craniopharyngiomas (5%) and the highest in ependymomas (13%). .
Conclusions: The risk factors for shunt failure in children with brain tumors can be quantified. Shunts placed in
children with brain tumors have lower rates of malfunction and higher rates of infection than seen in the overall
hydrocephalus population.
Supported by the Hematology/Oncology Education Program, Childrens Hospital Los Angeles, CA.
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