Perioperative risk factors for short term shunt revisions in adult hydrocephalus patients.

Abstract

The aim of this study was to prospectively study perioperative variables associated with revision after shunt surgery for adult hydrocephalus. Two protocols were designed to prospectively study perioperative risk factors during shunt insertion. Over 10 years (1995-2004), 450 adult (age >16 years) patients with first time shunt implantations were studied. Patients who had been treated with endoscopic third ventriculostomy were excluded from the study. All shunts were designated as meeting one of two end points: (1) shunt failure requiring revision within 6 months or (2) no shunt failure within 6 months. Shunt revision within 6 months postoperatively was considered to be related to the shunting procedure. 85 shunt revisions were performed within 6 months after insertion. During the study period the revision rate declined from 21.1% to 9.1%. Revision rates were the same for ventriculoperitoneal (n = 411) and ventriculoatrial (n = 39) shunts. The predictive values of variables related to the patient, operating room, surgical technique and shunt system were analysed to determine shunt outcome. Right frontal placement of the ventricular catheter was associated with the lowest rate of revisions. Adjustable valves were associated with a lower risk for shunt revision. Shunt revision rates did not differ between ventriculoperitoneal and ventriculoatrial shunts.