damage. The spread of a brain tumor outside of the central nervous system through a shunt can seriously complicate the treatment of the tumor. Heart, lung, and kidney failure, which can result from shunt infection or malfunction, can be life-threatening.

Reports of Complications

To examine the identification and attempts to devise ways of treating and preventing complications, we performed a search of the MEDLINE and OLDMEDLINE databases with the following strategy:

1

Exp HYDROCEPHALUS/co and exp HYDROCEPHALUS/su [Complications, Surgery]

560

2

exp Cerebrospinal Fluid Shunts/ae, mo [Adverse Effects, Mortality]

1,713

3

1 or 2

2,184

The 2,184 articles identified were then screened by title and abstract (where necessary) to identify those that dealt directly with complications of CSF shunts. A category of “general” was identified for comprehensive reviews of CSF shunts that might contain discussions of complications. This category of publication was used primarily in the early days of shunt experience. Only 13 of the 128 articles in this category were published after 1976.

The articles discussing complications were grouped according to type of complication. The large category of “malfunction” includes general studies of malfunction and specific studies of occlusion, disconnection (including fracture of the catheter), migration (of a portion of the system away from its site of implantation), and perforation of an organ by the distal catheter of the shunt system.

The large category of infection includes general studies of shunt malfunction and specific studies of shunt nephritis, infected abdominal cysts, or peritonitis.

Other identifiable categories of complication include uninfected abdominal cysts, intracranial hemorrhage caused by the shunt, tumor metastases through the shunt, pneumocephalus (symptomatic air in the head related to the shunt), slit ventricles (ventricles that become smaller than normal after shunting and are associated with symptoms), cardiopulmonary (including heart failure, pulmonary embolism, lung dysfunction, or catheters that perforate the heart or become loose in the vascular system), and death. Articles describing other complications or studying multiple types of complications were classified as “miscellaneous.” Table E.1 shows the distribution of the 1,272 articles. (The entire reference list is available upon request.)



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