Current epidemiology of cerebrospinal fluid shunt surgery in the UK and Ireland (2004–2013)

Abstract

ObjectivesTo determine current epidemiology and clinical characteristics of cerebrospinal fluid (CSF) shunt surgery, including revisions.MethodsA 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.Results41 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.ConclusionsOur 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.

Revision and complication rates in adult shunt surgery: a single-institution study

“…Overall infection rates have commonly been reported to be around 5–6% in adult patients [ 12 , 17 , 19 ] but also significantly higher (8–15%) [ 13 ]. In a recent epidemiological study, the infection rate was reported to be around 12% [ 5 ]. In the current study, the infection was the most common cause for the first revision.…”

Toll-like receptor linked cytokine profiles in cerebrospinal fluid discriminate neurological infection from sterile inflammation

“…The risk varies significantly with surgical procedure, duration and whether devices are implanted ( Kourbeti et al , 2015 ). The most common implanted devices are either temporary external ventricular drains (EVD) or permanent ventriculoperitoneal (VP) shunts for controlling hydrocephalus ( Fernández-Méndez et al , 2019 ). Both EVD and VP shunt insertion carry a significant risk of infection, with recent large UK prospective studies showing rates of 9.3% in 495 EVD insertions ( Jamjoom et al , 2018 ) and 6% in 1594 first VP shunts ( Mallucci et al , 2019 ).…”

A Reappraisal of the Necessity of a Ventriculoperitoneal Shunt After Decompressive Craniectomy in Traumatic Brain Injury

“…A positive response to the withdrawal of CSF has been reported to have a positive predictive value in the range of 73-100% [20][21][22]. In addition, VPS has well-known complications, such as wound healing problems, bleeding, malfunction, and infections [23,24]. It was also reported that when CP and VPS placement were performed simultaneously, the complication rate was higher than that of staged surgery [11,25].…”