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Key messages
Shunts may fail after many years without symptoms
Malfunction of a shunt should be considered with any unexplainedsymptoms or signs
Descriptions like "arrested hydrocephalus" or "shunt independent" can be misleading and delay diagnosis
All patients with spina bifida who have shunts need continuingcomprehensive care
Introduction
In a school population with many children with spina bifida and hydrocephalus a persisting incidence of malfunction of shunts, especially in the early teenage years, was observed. Two of these patients were stated to have arrested hydrocephalus and non-functioning shunts, hence causing delay and increased difficulty in making the diagnosis. Four patients died from shunt malfunction, two proved and two suspected. We therefore carried out a review of the whole group including all the school leavers to assess the importance of long term shunts in adults and whether complications with shunts continued to occur.
Method
We reviewed pupils who had attended Lord Mayor Treloar College for the physically disabled between 1978 and 1993. Of the 215 pupils with spina bifida, 179 (83%) had shunts. A questionnaire was sent to these 179 students or their families for completion and permission to review their medical notes. Contact was attempted initially via the Association for Spina Bifida and Hydrocephalus, and to those who did not respond a further attempt was made directly to their last known address at the time they left the college.
Results
Eighteen people refused to participate or allow examination of their medical notes; 39 did not respond to either attempt at contact; and 12 could not be traced as questionnaires were returned by the post office. The remaining 110 who were reviewed reflected the general age and sex distribution of the group (mean (range) age 21.5 (14-31) years, male:female ratio 1:1.3 in reviewed group; 24.3 (14-32) years, 1:1.3 in non-reviewed group).
As shunts have been replaced the ratio of ventriculoatrial to ventriculo-peritoneal shunts has fallen from about 25:1 to 2:1. The mean (range) number of operations per person for revision of shunts was 3.6 (0 to 28), but the mode was only one. Of these revisions, 72 were prophylactic and 320 were emergency operations. Thirty seven subjects required emergency revision operations in their first year, the incidence falling to 4% (4/110) at 10 years, only to rise...