In the 10-year period, 1973-82, 431 children underwent cerebrospinal fluid shunt insertion for hydrocephalus at Children’s Memorial Hospital, Chicago. The authors, now in Verona, Italy (Casella Postale 401.1-37100), have studied the relationship between the etiology of hydrocephalus, age at the time of shunt placement, and infection ate. Meningomyelocele was present in 40%, congenital communicating or obstructive hydrocephalus in 34%, and tumors in 18%. Intraventicular hemorrhage and meningitis were the causes in 5% and 3%, respectively. The age at surgery was less than 1 year in 83% and 1 week or younger in 18%. Each patient had an average of 3 procedures. Infections occurred as a complication of the shunt in 96 patients at rates of 22% per patient and 6% per procedure. Younger patients and those with meningomyelocele were most susceptible to infection. In the meningomyelocele group, infection occurred less often when shunted at 2 weeks of age or later, compared to 1 week or earlier, when the rate was 48%. [1]

COMMENT: The rate of operative shunt infection reported in this study is high, and the authors are able to cite similar statistics from two other centers. Attempts to reduce the incidence of infection by perioperative antibiotics or a surgical isolator had not been successful. If a rate of infection of 20% or more per patient is the rule with the operative treatment of hydrocephalus, a reappraisal of techniques and indications for surgery would seem to be a necessity.

Recent experience at Children’s Memorial Hospital indicates a rate of infection lower than that reported here, and Dr. Luis Yarsagaray at Loyola Stritch Medical Center, Chicago, recalls only 3 cases of shunt infection in a total of 2000 patients of all ages, both children and adults, that he has himself treated by surgery over a 17 year period (personal communication).