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Research paper
Current epidemiology of cerebrospinal fluid shunt surgery in the UK and Ireland (2004–2013)
  1. Rocío Fernández-Méndez1,2,
  2. Hugh K Richards1,2,
  3. Helen M Seeley1,2,
  4. John D Pickard1,2,3,
  5. Alexis J Joannides1,2,3
  6. UKSR collaborators
    1. 1 Clinical Neurosciences, University of Cambridge, Cambridge, UK
    2. 2 United Kingdom Shunt Registry, Cambridge, UK
    3. 3 NIHR Brain Injury MedTech Co-operative, Cambridge, UK
    1. Correspondence to Dr Rocío Fernández-Méndez, Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK; rociofmendez.inv{at}


    Objectives To determine current epidemiology and clinical characteristics of cerebrospinal fluid (CSF) shunt surgery, including revisions.

    Methods A retrospective, multicentre, registry-based study was conducted based on 10 years’ data from the UK Shunt Registry, including primary and revision shunting procedures reported between 2004 and 2013. Incidence rates of primary shunts, descriptive statistics and shunt revision rates were calculated stratified by age group, geographical region and year of operation.

    Results 41 036 procedures in 26 545 patients were submitted during the study period, including 3002 infants, 4389 children and 18 668 adults. Procedures included 20 947 (51.0%) primary shunt insertions in 20 947 patients, and 20 089 (49.0%) revision procedures. Incidence rates of primary shunt insertions for infants, children and adults were 39.5, 2.4 and 3.5 shunts per 100 000 person-years, respectively. These varied by geographical subregion and year of operation. The most common underlying diagnoses were perinatal intraventricular haemorrhage (35.3%) and malformations (33.9%) in infants, tumours (40.5%) and malformations (16.3%) in children, and tumours (24.6%), post-haemorrhagic hydrocephalus (16.2%) and idiopathic normal pressure hydrocephalus (14.2%) in adults. Ninety-day revision rates were 21.9%, 18.6% and 12.8% among infants, children and adults, respectively, while first-year revision rates were 31.0%, 25.2% and 17.4%. The main reasons for revision were underdrainage and infection, but overdrainage and mechanical failure continue to pose problems.

    Conclusions Our report informs patients, carers, clinicians, providers and commissioners of healthcare, researchers and industry of the current epidemiology of shunting for CSF disorders, including the potential risks of complications and frequency of revision.

    • Neurosurgery
    • CSF shunting
    • Epidemiology
    • Registry

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    • Twitter The first epidemiology study of CSF Shunting based on the UK Shunt Registry is now available is a collective national effort, supported by SBNS, NIHR Brain Injury MIC, MHRA, SHINE and SBH Scotland to improve our knowledge on this life-saving procedure

    • Collaborators UKSR Collaborators: David Allcutt; Fiona Arnold; Richard Ashpole; Eric Ballantyne; Cristina Bleil; Howard Brydon; Diederik Bulters; Marian Byrne; Tom Cadoux-Hudson; Claire Cairns; Kerry Cameron; Maria Cartmill; Christopher Chandler; Munchi S Choksey; Sally-Ann Collins; Kimona Colthrust; Claudia Craven; Darach Crimmins; Giles Critchley; Matthew Crocker; Simon Cudlip; Marek Czosnyka; Zofia Czosnyka; Linda D’Antona; Emma Dewhurst; Laurence Dunn; Richard Edwards; Fiona Evans; Helen Fernandes; Amy Fieldsend; Graham Flint; Matthew Garnett; Aprajay Golash; John Goodden; Lois Gourley; Jennifer Hallet; Jan Hardy; Dawn Hennigan; Katie Herbert; Liz Hinde; Damian Holliman; Peter Hutchinson; Michael Jenkinson; Ian Kamaly; Jothy Kandasamy; Nicole Keong; Sara Kewin; Andrew King; Angelos Kolias; Sarah Kvedaras; Afroditi Lalou; Paul Leach; Donald MacArthur; Conor Mallucci; John Martin; Bruce Mathew; Roy McConnell; Catherine McMahon; John McMullan; Emma Moran; Nitin Mukerji; Eva Nabbanja; Roddy O’Kane; Jody O’Connor; Gerry O’Reilly; Marios Papadopoulos; Ian Pople; Chittoor Rajaraman; Roberto Ramirez; Joana Ramos; Sheila Ross; Nicholas Ross; Thomas Santarius; Amar Saxena; Mano Shanmuganathan; Saurabh Sinha; Guirish Solanki; Roger Strachan; Dominic Thompson; Simon Thompson; John Thorne; Lewis Thorne; Kim Thurlby; Martin Tisdall; Simon Tizzard; Lorraine Todd; Ahmed Toma; Carole Turner; Shungu Ushewokunze; Raghu Vindlacheruvu; John Wadley; Laurence Watkins; Peter Whitfield; Mark Wilson; Bassel Zebian.

    • Contributors JDP established the UK Shunt Registry in 1993 and has had overall responsibility up to the present time. HKR and HMS contributed to data acquisition, data management and storage and quality assurance of the UKSR. RFM, AJJ and JDP conceived the analysis plan, RFM carried out data quality checks, cleansing and analyses, and all authors contributed to data interpretation. RFM drafted the manuscript and all remaining authors critically revised it. All authors approved the final version of the manuscript for publication.

    • Funding UKSR participating NHS Trusts and National Institute for Health Research.

    • Competing interests The UKSR is supported by annual subscription fees from each participating institution. Support for a research fellowship program has been established by industry, who receive data on the performance and usage of their own products to facilitate their post-marketing surveillance. The UK Shunt Registry has complete independence over data collection, analysis and publication. AJJ is supported by an NIHR academic clinical lectureship award. JDP was an NIHR Senior Investigator (2009–2014) and is Honorary Clinical Director of the NIHR Brain Injury Health Technology Co-operative (2012–2017), now MedTech Co-operative (2018–2023). The registry has responsibilities to the Society of British Neurological Surgeons and the Medicines and Healthcare products Regulatory Agency.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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