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Peri-operative risk factors for short-term revision in adult hydrocephalus patients
  1. Dan Farahmand (dan.farahmand{at}
  1. Institute of Clinical Neuroscience, Sweden
    1. Halfdan Hilmarsson (halfdan.hilmarsson{at}
    1. Institute of Clinical Neuroscience, Sweden
      1. Mats Högfeldt (mats.o.johansson{at}
      1. Institute of Clinical Neuroscience, Sweden
        1. Magnus Tisell (magnus.tisell{at}
        1. Institute of Clinical Neuroscience, Sweden


          Objectives: The aim of this study was to prospectively study perioperative variables associated with revision after shunt surgery for adult hydrocephalus.

          Methods: Two protocols were designed to prospectively study perioperative risk factors during shunt insertion. During 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 endpoints: 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.

          Results: Eighty-five 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.

          Conclusions: 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.

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