Revision surgery following CSF shunt insertion: how often could it be avoided?

Stefanie Kaestner ^1 2, Manuela Poetschke ³, Uwe Kehler ⁴, Sebastian Antes ⁵, Matthias Krause ⁶, Wolfgang Deinsberger ^7 8Affiliations expand

• PMID: 31667581
• DOI: 10.1007/s00701-019-04083-0

Abstract

Background: Cerebrospinal fluid (CSF) shunt revision surgery represents a huge social and economic burden. Few studies, however, have evaluated shunt revision surgeries in the context of their avoidability, and existing data are from paediatric populations. Using ratings from an expert panel, we classified avoidable and unavoidable shunt revisions in a mixed cohort of CSF-shunt patients.

Methods: In a retrospective review of a prospectively maintained, single-centre database, we identified all shunt systems implanted for the first time over a 10-year period (2007-2016) and all subsequent revision surgeries with a follow-up of at least 1 year. A panel of five expert shunt surgeons classified each revision surgery as avoidable or unavoidable. Rates of each were calculated and correlated with clinical data.

Results: Of 210 revision surgeries (314 patients, mean age, 49.9 years; mean follow-up, 4.2 years), the panel judged 114 as unavoidable (54.3%) and 96 (45.7%) as avoidable. Level of surgeon education correlated with these rates, but even in the most experienced hands, 12.5% of revisions were classified as avoidable. Avoidable revisions occurred significantly earlier than unavoidable interventions (mean; 112 and 448 days, respectively) after the index surgery.

Conclusion: Rates of avoidable shunt revision surgery are alarmingly high, even in experienced hands. Avoidable revisions occur significantly earlier, predominantly within the first 3 months after the index surgery.

Keywords: Avoidable; Hydrocephalus; Revision surgery; VP shunt.

Similar articles

• Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus.Reddy GK, Bollam P, Caldito G.World Neurosurg. 2014 Feb;81(2):404-10. doi: 10.1016/j.wneu.2013.01.096. Epub 2013 Feb 4.PMID: 23380280
• Ventriculoperitoneal shunt complications needing shunt revision in children: a review of 5 years of experience with 48 revisions.Ghritlaharey RK, Budhwani KS, Shrivastava DK, Srivastava J.Afr J Paediatr Surg. 2012 Jan-Apr;9(1):32-9. doi: 10.4103/0189-6725.93300.PMID: 22382102
• Role of radiological parameters in predicting overall shunt outcome after ventriculoperitoneal shunt insertion in pediatric patients with obstructive hydrocephalus.Patra DP, Bir SC, Maiti TK, Kalakoti P, Cuellar H, Guthikonda B, Sun H, Notarianni C, Nanda A.Neurosurg Focus. 2016 Nov;41(5):E4. doi: 10.3171/2016.8.FOCUS16263.PMID: 27798979
• Ventriculosubgaleal shunting–a strategy to reduce the incidence of shunt revisions and slit ventricles: an institutional experience and review of the literature.Petraglia AL, Moravan MJ, Dimopoulos VG, Silberstein HJ.Pediatr Neurosurg. 2011;47(2):99-107. doi: 10.1159/000330539. Epub 2011 Sep 13.PMID: 21921577 Review.
• Rate and Risk Factors for Shunt Revision in Pediatric Patients with Hydrocephalus-A Population-Based Study.Tervonen J, Leinonen V, Jääskeläinen JE, Koponen S, Huttunen TJ.World Neurosurg. 2017 May;101:615-622. doi: 10.1016/j.wneu.2017.02.030. Epub 2017 Feb 14.PMID: 28213196 Review.