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Cranial Vault Remodeling in Children with Ventricular Shunts
Nicholas Sinclair MD; Carlos Ordenana MD; Joan Lee BS; Violette Recinos MD; Francis Papay MD; Antonio Rampazzo MD,PhD; Bahar Bassiri Gharb MD, PhD
Cleveland Clinic Foundation, Integrated Plastic Surgery
2019-02-15
Presenter: Nicholas Sinclair, MD
Affidavit:
I approve of this submission.
Director Name: Steven Bernard, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction
Cranial vault surgery in children with ventricular shunts has an added level of complexity due to potential interference of shunt location with surgical planning and risk of shunt related complications. This study evaluates the management of ventricular shunts during cranial vault remodeling (CVR).
Methods
A retrospective chart review was performed of all patients undergoing CVR in the presence of ventricular shunt at a single institution. CVR indication, neurological findings, suture status, and shunt management during CVR were assessed. Measured outcomes were number of shunt revisions following CVR, Whitaker classification, and complication rates.
Results
11 patients met inclusion criteria. The most common indication for CVR was shunt-induced craniosynostosis (64%, n=7), followed by syndromic craniosynostosis (18%, n=2) and macrocephaly (18%, n=2). Ventricular shunt was not exposed in 18%; exposed in 54%; and simultaneously exposed and revised in 18%. Two patients experienced complications within 30-days. In one patient, the shunt had not been exposed; in the other patient, the shunt was exposed and revised. Three additional patients experienced complications within 3-months. In all three, the shunt was exposed, but not revised. 2.2 shunt revisions per patient were performed following CVR. Post-operatively, eight patients were Whitaker class I and three were Whitaker class III.
Conclusions
Cranial vault abnormalities in the presence of a ventricular shunt can be safely and effectively treated with CVR. There is no single best approach to intra-operative management of the ventricular shunt during CVR. While leaving the shunt unexposed may appear less morbid, shunt related complications can still occur with this approach.
