| A Search for Deterninants of Ventriculoperitoneal Shunt Failure : Retrospective Analysis of 12 Years Experience |
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Hyun-Jin Hong, Seong-Joon Kim, Ik-Seong Park, Min-Woo Baik |
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Department of Neurosurgery, St. Mary's Hospital, College of Medicine, Catholic University, Bucheon, Korea |
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| Abstract |
Introduction: Ventriculoperitoneal (VP) shunt is a long-standing treatment of choice for hydrocephalus. Despite the rapid evolution of shunt devices and procedures, shunt failure remain a significant cause of morbidity and a major limitation in the successful treatment of hydrocephalus. In trying to reduce the rate of shunt malfunction, it is necessary to define and understand the causes and risk factors of these complications. Thus, we conducted a retrospective study of 218 VP shunt to examine VP shunt complication rates and to determine factors that may be associated with increased risk of shunt complications
Material and Method: Over a period of 11 years and 5 months, 226 VP shunt surgeries were performed at our center. Patients who experienced the first neurosurgical surgery not at our center and one who died during the follow-up period were excluded. Therefore, 218 patients were enrolled in this study. We reviewed a database containing information on patients with hydrocephalus treated between January 1999 and the end of May 2010. This database included information about patient's sex and age, specific causes of hydrocephalus, types of valve were used, the position of the burr hole, surgeon's experience and duration of operation.
Result: During the period covered by the study, 32 VP shunts were revised and overall shunt failure rate was 14.7%. Shunt failure rate was not different between two sexes. Failure rates were slightly higher in groups of younger age, Kocher's point of burr hole, intracerebral hemorrhage (ICH) or intraventricular hemorrhage (IVH) and infection and experienced surgeon, but they did not reach statistical significance. Finally, in groups of programmable valve, shunt failure rates are lower with statistical significances (p= 0.006). In shunt failure, the mean duration of surgery was significantly longer. And when experienced surgeon participated in the surgeries, the duration of surgery was significantly shorter.
Conclusion
We found that valve type is associated with increased risk of VP shunt complications. In our analysis and a review of the published literatures, younger age, hydrocephalus caused by infection, surgeon's immature experience, mean duration of operation appeared to increase the risk of shunt complication. Therefore we suggest that when the risk factors above are present in patients who need CFS shunt, surgeons should pay careful attention to possible complications. |
| Key Words:
Ventriculoperitoneal shunt, Shunt failure, Complication, Risk factor, Valve types. |
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