Long-term risk of shunt failure after brain tumor surgery

Sayied Abdol Mohieb Hosainey,Benjamin Lassen Lykkedrang,Torstein R Meling

doi:10.1007/s10143-021-01648-5

Abstract

Long-term risks and survival times of ventriculoperitoneal (VP) shunts implanted due to hydrocephalus (HC) after craniotomy for brain tumors are largely unknown. The aim of this study was to establish the overall VP shunt survival rates during a decade after shunt insertion and to determine risks of shunt failure after brain tumor surgery in the long-term period. In this population-based cohort from a well-defined geographical region, all adult patients (> 18 years) from 2004 to 2013 who underwent craniotomies for intracranial tumors leading to VP shunt dependency were included. Our brain tumor database was cross-linked to procedure codes for shunt surgery (codes AAF) to extract brain tumor patients who became VP shunt dependent after craniotomy. The VP shunt survival time, i.e. the shunt longevity, was calculated from the day of shunt insertion after brain tumor surgery until the day of its failure. A total of 4174 patients underwent craniotomies, of whom 85 became VP shunt dependent (2%) afterwards. Twenty-eight patients (33%) had one or more shunt failures during their long-term follow-up, yielding 1-, 5-, and 10-year shunt success rates of 77%, 71%, and 67%, respectively. Patient age, sex, tumor location, primary/repeat craniotomy, placement of external ventricular drainage (EVD), ventricular entry, post-craniotomy hemorrhage, post-shunting meningitis/infection, and multiple shunt revisions were not statistically significant risk factors for shunt failure. Median shunt longevity was 457.5 days and 21.5 days for those with and without pre-craniotomy HC, respectively (p < 0.01). This study can serve as benchmark for future studies.

Highlights

Surgical resection of brain tumors is considered to be the primary choice of treatment for patients with debilitating neurological symptoms
The following patient demographics were recorded: age at time of shunt insertion, sex, status of hydrocephalus prior to craniotomy, tumor location, intra-axial or extra-axial tumor location, primary/repeat tumor resection, histology, external ventricular drainage (EVD) placement, ventricular opening during craniotomy, post-craniotomy hemorrhage, post-craniotomy meningitis/infection, and number of shunt revision procedures with confirmed shunt failures
In order to identify patients who underwent an EVD procedure before, during, and/or after craniotomy, and definitive VP shunting after brain tumor surgery, our tumor database was cross-linked with our surgical procedure code database using the Nordic Medico-Statistical Committee Classification of Surgical Procedures (NCSP) codes for cerebrospinal fluid (CSF)-related procedures

Summary

Introduction

Surgical resection of brain tumors is considered to be the primary choice of treatment for patients with debilitating neurological symptoms. Studies of shunt failures with respect to the congenital conditions in the pediatric population [23, 26, 39], hemorrhage-related HC [12], idiopathic conditions [1, 35], and infections [26, 29] have been published, reports on risks of long-term shunt longevity after brain tumor surgery remain scarce in the literature [12, 37, 38]

Objectives

Methods

Results

Discussion

Conclusion