Highlights

Abstract

Keywords

۱٫ Introduction

۲٫ Materials

۳٫ Methods

۴٫ Experimental results and discussion

۵٫ Conclusion

Declaration of competing interest

References

Abstract

Hydrocephalus is defined as the increase in Cerebro Spinal Fluid (CSF) volume, which is usually accompanied by high Intracranial Pressure (ICP). The most common treatment for hydrocephalus is ventriculoperitoneal shunt insertion. Shunt is a tube which drains CSF from the ventricular system to peritoneal cavity. Then, the CSF is absorbed from peritoneum. Infection is considered as one of the most complications of shunt systems, which can cause improper prognosis in patients, especially in children’s neuro development. Hence, identifying shunt infection predictive factors could improve the practice in preventing this event. This study used a dataset containing the features of 68 patients with a history of shunt infection and 80 patients without any history of shunt infection (control group) in Children’s Medical Center hospital of Tehran (Iran). The state-of-art techniques were applied to select the most informative predicting factors (features). The probability (accuracy) of shunt infection was determined with different intelligent and statistical classifiers. The results indicated that history of prematurity and intraventricular hemorrhage, age of the first shunt procedure, number of shunt revisions, brain tumor induced hydrocephalus, birth weight, and coinfection are the best descriptive features. In addition, the best classification results by different techniques varied in the accuracy range of 68%–۸۱% in the dataset.

۱٫ Introduction

Cerebro Spinal Fluid (CSF) is continuously made by Central Nervous System (CNS), which carries nutrients, washes away impurities, and acts as a cushion for CNS. After production, it flows through ventricles and sub-arachnoid space and is finally absorbed by brain venous blood stream. A precise balance between the production and absorption of CSF is necessary to maintain normal Intra-Cranial Pressure (ICP). There is an excessive amount of CSF in hydrocephalus intradural space, which could be related to an obstruction in CSF flow or a defect in absorption to brain blood flow [1].

In general, it occurs in 1–۲ per 100 live births in children and adults. Several different situations such as tumors, infections, trauma, developmental abnormalities, and other factors can cause hydrocephalus. Hydrocephalus, as a neurosurgical emergency, increases head circumstance, decreases vision, less of consciousness and some other neurodevelopmental deficits. Ventricular shunt placement is considered as the most common treatment for symptomatic hydrocephalus. Shunt is an internal tube which drains CSF from ventricles to other places in the body in order to absorb the extra fluid and preserve normal ICP [2,3].

Shunt has several complications despite its numerous benefits, the most common complication of which is its infection, which has many morbidities, especially in the neurodevelopmental growth of the affected children and enormous economic costs for healthcare systems. The rate of shunt infection varies from 10% to 22%, and approximately 90% of the infections usually occur one month after surgery. There are some potential predisposing factors for shunt infection such as the patient’s age, etiology of hydrocephalus, hospitalization period, number of shunt revisions, surgeon’s experience, operation duration, surgical technique, manipulation of the indwelling device during surgery, and health insurance [4].