Observations regarding failure of cerebrospinal fluid shunts early after implantation

Abstract

Despite advances in cerebrospinal fluid (CSF) diversionary techniques, shunt failure due to infection or malfunction remains a persistent problem in hydrocephalus care. The aim of this study was to evaluate the independent predictors of early shunt survival after implantation in a large cohort of patients. The authors retrospectively reviewed the records of all patients who had undergone shunt implantation procedures at their institution during an 8-year period. They analyzed the independent predictors of shunt survival in 116 failed shunt placement procedures (infection or malfunction) by performing univariate and multivariate factorial analyses. Analysis of the 116 failed shunts in the 396 new shunt placement procedures performed revealed that age was a significant independent predictor of shunt survival time in failures due to malfunction (p < 0.05) as well as infection (p < 0.05). In addition, a significant relationship between patient race and shunt survival was also found. As suggested by data in other studies focused on this outcome, early shunt failure occurs sooner in younger patients. Interestingly, this study is one of few whose data have revealed that race may affect shunt failure after implantation. Specifically, shunt failure due to infection resulted in significantly shorter shunt survival time in non-white patients compared with that in white patients. Among the shunts that failed due to malfunction, however, white patients had shorter shunt survival times.