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.