Abstract
Background:Ventriculoperitoneal (VP) shunt insertion remains the mainstay of treatment for hydrocephalus despite a high rate of complications. The predictors of shunt malfunction have been studied mostly in pediatric patients. In this study, we report our 11-year experience with VP shunts in adult patients with hydrocephalus. We also assess the various factors affecting shunt survival in a developing country setting.Methods:A retrospective chart analysis was conducted for all adult patients who had undergone shunt placement between the years 2001 and 2011. Kaplan–Meier curves were used to determine the duration from shunt placement to first malfunction and log-rank (Cox–Mantel) tests were used to determine the factors affecting shunt survival.Results:A total of 227 patients aged 18–85 years (mean: 45.8 years) were included in the study. The top four etiologies of hydrocephalus included post-cranial surgery (23.3%), brain tumor or cyst (22.9%), normal pressure hydrocephalus (15%), and intracranial hemorrhage (13.7%). The overall incidence of shunt malfunction was 15.4% with the median time to first shunt failure being 120 days. Etiology of hydrocephalus (P = 0.030) had a significant association with the development of shunt malfunction. Early shunt failure was associated with age (P < 0.001), duration of hospital stay (P < 0.001), Glasgow Coma Scale (GCS) score less than 13 (P = 0.010), excision of brain tumors (P = 0.008), and placement of extra-ventricular drains (P = 0.033).Conclusions:Patients with increased age, prolonged hospital stay, GCS score of less than 13, extra-ventricular drains in situ, or excision of brain tumors were more likely to experience early shunt malfunction.
Highlights
Ventriculoperitoneal (VP) shunt insertion remains the mainstay of treatment for hydrocephalus despite a high rate of complications
Ventriculoperitoneal (VP) shunt placement is the mainstay of treatment for hydrocephalus in both adult and pediatric patients.[2,5,28,33,43]
We report an 11‐year experience of managing adult hydrocephalus, including etiologies of disease, patient demographics, shunt survival and failure rate, and causes of shunt malfunction
Summary
A retrospective chart analysis was conducted for all adult patients who had undergone shunt placement between the years 2001 and 2011. We performed a retrospective chart review using our inpatient database. Adult patients were defined as those who were 18 years of age or older. Each file was individually reviewed for various details such as patient demographics, presentation, neurological examination, laboratory and radiological investigations, medical and surgical management, hospital stay, follow‐up, and further management. Follow‐up in neurosurgery clinics was reviewed for periodic shunt assessment, persistent or new onset symptoms, and any neurological deficits in terms of visual symptoms and motor and cognitive deficits. In case of shunt malfunction, cause and delay from first insertion to revision were studied. Any and all further hospital admissions and surgeries were studied
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