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Postoperative cerebrospinal fluid wound leakage as a predictor of shunt infection: A prospective analysis of 205 cases
Journal of Neurosurgery: Pediatrics, 08/05/09

Jeelani NuO et al. – The presence of a perioperative cerebrospinal fluid (CSF) leak for pediatric pts is associated with a very high risk of shunt infection. Optimal management beyond prevention of such CSF leaks is pending further study.

Methods

Study of risk factors for CSF shunt infections within authors' practice
Analysis of statistical significance for all shunt procedures over 2-yr period
Positive CSF cultures prerequisite to qualify as shunt infection
Assessment of effects of pt age, hydrocephalus etiology, surgery as primary shunt placement/revision and elective/emergent, surgeon's experience level, and presence/absence of perioperative CSF leak

Results

Of 205 pts (mean [± SD] age at surgery: 27.9 ± 43.0 mo), shunt infections in 17 pts (8.3%) at median of 42 days postoperatively (range 14–224 days)
Presence of perioperative CSF leak was only variable with statistically significant association with shunt infection occurrence; infection rate of 57.1% vs 4.7% in cases with no leak
No effect on infection risk: hydrocephalus cause, elective vs emergency surgery, surgeon experience level, primary vs revision procedure, and pt age

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