Neurocirugía Neurocirugía
Neurocirugia.1995;6:205-10 - Vol. 6 Núm.3 DOI: 10.1016/S1130-1473(95)70781-3
Derivaciones de líquido cefalorraquídeo. Resultados y complicaciones
I. Pomposo, J. Aurrecoechea, I. Menchacatorre, M. Urigüen, J. Zorrilla, J. Garibi
Servicio de Neurocirugía del Hospital de Cruces (Baracaldo). Facultad de Medicina. Universidad del País Vasco
Resumen

La derivación de líquido cefalorraquídeo (LCR) es un procedimiento quirúrgico ampliamente utilizado en el tratamiento de la hidrocefalia y en otras alteraciones de la dinámica del LCR. A pesar de su popularidad, esta intervención frecuentemente requiere revisión quirúrgica. Se ha realizado un análisis retrospectivo de las derivaciones implantadas en 245 pacientes en nuestro Centro entre Enero de 1985 y Diciembre de 1993. Aparecieron complicaciones en 87 pacientes (35,5%), precisándose un total de 394 intervenciones, de las cuales 359 fueron procedimientos de implantación, completo o parcial, de un sistema derivativo. Las causas más frecuentes de fallo del shunt, por procedimiento, fueron: la obstrucción mecánica en 39 casos (10,85%), de causa no determinada en 35 (9,75%) y la infección en 31 (8,64%). Dos ‘pacientes fallecieron por complicaciones directamente relacionadas con esta técnica (0,51% por intervención).

Summary

Cerebrospinal fluid (CSF) shunting is a surgical procedure widely employed in the treatment of hydrocephalus and other disturbances of CSF dynamics. In spite of its popularity, this operation frequentIy requires surgical revision. A retrospective analysis of a series of 245 patients who underwent the insertion of a CSF shunt between January 1985 and December 1993 was performedo Complications occurred in 87 patients (35,5%), who required a total of 394 operations, of which 359 consisted in the complete or parcial implantation of a shunt device. The most frequent causes of shunt revision, were: mechanical obstruction in 39 cases (10,8%), undetermined cause in 35 (9,7%), and infection in 31 (8,6%). Two patients died from complications directly related with the operations (0,51% per operation).

Palabras clave
Hidrocefalia, derivación de LCR
Key words
Hydrocephalus, cerebrospinal fluid shunting
El Texto completo solo esta disponible en PDF
Bibliografía
1.
E.F. Aldrich,P. Harmann
Disconection as a cause of ventriculoperitoneal shunt malfunction in rriulticomponent shunt systems
Pediatr. Neurosurg., 16 (1991), pp. 309-311
2.
J.A. Alvarez-Garijo,M.V. Mengual
Infection rate with and without prophylactic antibiotic therapy after shunt insertion for hydrocephalus
Monogr. Neuorol. Sci., 8 (1982), pp. 66-68
3.
K.S. Bierbrauer,B.B. Storrs,D.G. Mclone,T. Tomita,R. Dauser
A prospective, randomized study of shunt function and infections as a function of shunt placement
Pediatr. Neurosurg., 16 (1990–1991), pp. 287-291
4.
M. Choux,L. Genitori,D. Lang,G. Lane
Shunt implantation: reducing the incidence of shunt infection
J. Neurosurg., 77 (1992), pp. 875-880
5.
J. Fandiño Rivera,C. Botana López,A. Viladrich Carreira,J.L. Quintela Berrnúdez,J. Antelo Cortizas,J. Gómez Bueno
Derivación ventrículo peritoneal en el tratamiento de la hidrocefalia infantil Resultados y complicaciones
An. Esp. Pediatr., 32 (1990), pp. 325-328
6.
K. Faulfaher,P. Schmitz
Overdrainage phenomena in shunt treated hydrocephalus
Acta Neurochir (Wien), 45 (1978), pp. 89-101
7.
A.H. Ferguson
Intraperitoneal diversion of the cerebrospinal fluid in cases of hydrocephalus (review)
N. Y. Med. J., 67 (1898), pp. 902
8.
E.L. Foltz,J.P. Blanks
Symptomatic low intracranial pressure in shunted hydrocephalus
J Neurosurg., 68 (1988), pp. 401-408
9.
E.L. Foltz
Hydrocephalus: slit ventricles, shunt obstructions, and third ventricle shunts: a clinical study
Surg. Neurol., 40 (1993), pp. 119-124
10.
P. Gardner,T.J. Laipzig,M. Sadigh
Infections of mechanical cerebrospinal fluid shunts
Curro Clin. Top. Infect. Dis., 9 (1988), pp. 185-214
11.
S.R. Guertin
Cerebrospinal fluid shunts Evaluation, complications, and crisis management
Pediatr. Clin. North. Am., 34 (1987), pp. 203-217
12.
J.F. Hirsch,E. Hoppe-Hirsch
Shunts and shunt problems in childhood
Adv. Tech. Stand. Neurosurg., 16 (1988), pp. 177-196
13.
J.F. Hirsch
Surgery of hydrocephalus: past, present and future
Acta Neurochir. (Wien), 116 (1992), pp. 155-160
14.
J.M. Langley,J.C. Leblanc,J. Drake,R. Milner
Efficacy of antimicrobial prophylaxis in placement of cerebrospinal fluid shunts: meta-analysis
Clin. Infect. Dis., 17 (1993), pp. 98-103
15.
A.E. Marlin,S.J. Gaskill
Cerebrospinal fluid shunts: complications and results
Pediatric Neurosurgery, pp. 221-233
16.
lF. Martínez-Lage,M. Poza,J.A. Esteban
Mechanical complications of the reservoirs and flushing devices in ventricular shunt systems
Br. l Neurosurg., 6 (1992), pp. 321-325
17.
I.K. Pople,R. Bayston,R.D. Hayward
Infection of cerebrospinal fluid shunts in infants: a study of etiological factors
J. Neurosurg., 77 (1992), pp. 29-36
18.
E.M. Post
Currently available shunt systems: a review
Neurosurgery., 16 (1985), pp. 257-260
19.
A. Puca,C. Anile,G. Maira,G. Rossi
Cerebrospinal fluid shunting for hydrocephalus in the adult: factors related to shunt revision
Neurosurgery., 29 (1991), pp. 822-826
20.
R.H. Pudenz
The surgical treatment of hidrocephalusAn historical review
Surg. Neurol., 15 (1981), pp. 15-26
21.
R.H. Pudenz,E.L. Foltz
Hydrocephalus: overdrainage by ventricular shunts. A review and recommendations
Surg. Neurol., 35 (1991), pp. 200-212
22.
A.J. Raimondi
Shunts, indications, problems and characteristics
Child. Nerv. Syst., 4 (1988), pp. 312-324
23.
H.L. Rekate
Treatment of hydrocephalus
Pediatric Neurosurgery, pp. 202-220
24.
H.L. Rekate
Shunt revision: complications and their prevention
Pediatr. Neurosurg., 17 (1991), pp. 155-162
25.
D. Renier,J. Lacombe,A. Pierre-Kahn,c. Sainte-Rose,J.F. Hirsch
Factors causing acute shunt infection. Computer analysis of 1174 operations
J. Neurosurg., 61 (1984), pp. 1072-1078
26.
C. Sainte-Rose,J.H. Piatt,D. Renier,A. Pierre-Kahn,J.F. Hirsch,H.J. Hoffman,R.P. Humphreys,E.B. Hendrick
Mechanical complications in shunts
Pediatr. Neurosurg., 17 (1991), pp. 2-9
27.
J. Sekhar,J. Moossy,N. Guthkelch
Malfunctioning ventriculo-peritoneal shunts. Clinical and pathological features
J. Neurosurg., 56 (1982), pp. 411-416
28.
G. Spanu,G. Karussos,D. Adinolfi,N. Bonfanti
An analysis of cerebrospinal fluid shunt infections in adults. A clinical experience of twelve years
Acta Neurochir. (Wien), 80 (1986), pp. 79-82
29.
B.C. Walters,H.J. Hoffman,E.B. Hendrick,R.P. Humphreys
Cerebrospinal fluid shunt infection. Influences on initial management and subsequent outcome
J. Neurosurg., 60 (1984), pp. 1014-1021

Pomposo, I.; Aurrecoechea, J.; Menchacatorre, I.; Urigüen, M.; Zorrilla, J.; Garibi, J.: Derivaciones de líquido cefalorraquídeo. Resultados y complicaciones. Neurocirugía 1995; 6: 205–210.

Copyright © 1995. Sociedad Española de Neurocirugía
Neurocirugia.1995;6:205-10 - Vol. 6 Núm.3 DOI: 10.1016/S1130-1473(95)70781-3