The comparison of pressure-regulated antibiotic-impregnated shunt body and catheter systems with pressure-regulated antibiotic-impregnated ventriculoperitoneal catheter systems in the treatment of hydrocephalus

Objective: Hydrocephalus is a disease in which the balance between cerebrospinal fluid production and absorption is deteriorated. Despite performing various medical methods during the treatment, surgery is considered the main treatment. The most commonly preferred way in surgery is ventriculoperitoneal shunt surgery. One of the most observed complications in shunt surgery is the development of shunt infection. In our study, we aimed to compare the infection rates of shunt systems with antibiotic-impregnated and pressure-regulated shunts and catheters and of shunt systems with antibiotic-impregnated and pressure-regulated ventriculoperitoneal catheters. Materials and methods: 120 patients to whom ventriculoperitoneal shunt was placed with the diagnosis of hydrocephalus between January 2018 and July 2021 in the Department of Neurosurgery, Faculty of Medicine, Çukurova University were analysed retrospectively. Shunt systems with antibiotic-impregnated ventriculoperitoneal catheters were placed to 90 of these patients and shunt systems with antibiotic-impregnated and pressure-regulated shunts and catheters were placed to 30 of these patients. Data from the files, notes about operation, radiological and laboratory tests, and outpatient follow-up notes of all patients to whom ventriculoperitoneal shunt were placed were retrospectively reviewed for at least 6 months beginning from the date of operation. Results: 120 patients in total, 90 of which (75%) were with antibiotic-impregnated catheters and 30 of which (25%) with both antibiotic-impregnated catheters and valves, were included in the study. Of the patients included in the study, 74 (61.7%) of them were male and 46 (38.3%) of them were female. The mean age of the patients was 17.9±21.7 years. It was determined that 32 (26.7%) patients were 1 year old and under, and 88 (73.3%) patients were over 1 year old. The infection rate of the patients to whom shunt systems antibiotic-impregnated only ventriculoperitoneal catheters were implemented was 28.9% and the infection rate of the patients to whom shunt systems antibiotic-impregnated both valves and ventriculoperitoneal catheters were implemented was 10 %. This was considered statistically significant (p=0,036; p<0.05). It was found that infection rates decreased in patients to whom shunt systems antibiotic-impregnated both valves and ventriculoperitoneal catheters were implemented. The infection rate was 37.5% in patients aged 1 year old or under and congenital hydrocephalus etiology was found as 84.4% in these patients. It was determined that the patients who developed infection underwent a revision operation and their revision surgeries increased their shunt infection rates significantly when compared to their first operation. It was also revealed that the majority of the patients who developed infection was 1 year old and under and they had congenital hydrocephalus etiology. Discussion: It was understood from the literature review that infection developed in 5-22% of the patients to whom standard shunt system was implemented and in 9-2 % of the patients to whom antibiotic-regulated shunt system was implemented. It was also stated that antibiotic-impregnated shunts decreased the infection rates significantly. In our study, the infection rate of the patients to whom shunt systems antibiotic-impregnated only ventriculoperitoneal catheters were implemented was 28.9% and the infection rate of the patients to whom shunt systems antibiotic-impregnated both valves and ventriculoperitoneal catheters were implemented was 10 %. It was concluded that shunts the valves of which were also antibiotic-impregnated were more effective in decreasing infection rates unlike the other antibiotic-impregnated shunts (p=0.036; p<0.05). Keywords: Hydrocephalus, Ventriculoperitoneal shunt, Antibiotic-impregnated shunt