Long-term risk of shunt failure after brain tumor surgery

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.

Long-term follow-up and comparison of programmable and non-programmable ventricular cerebrospinal fluid shunts among adult patients with different hydrocephalus etiologies: a retrospective cohort study

“…As for the other etiologies, such as brain neoplasm, ischemic stroke, central nervous system (CNS) infection, no difference in the initial revision rate, total revision rate, and revision-free survival between PV and NPV groups was observed. Tumor-related hydrocephalus patients with ventricular CSF shunts were reported to have a shunt failure rate around 33% [ 15 , 32 ], which is in accordance with our results. Sex, age, tumor location, previous EVD placement, previous craniotomy, post-craniotomy hemorrhage, and post-craniotomy meningitis were found as non-significant risk factors for revision in adult brain tumor patients [ 15 ].…”

“…Tumor-related hydrocephalus patients with ventricular CSF shunts were reported to have a shunt failure rate around 33% [ 15 , 32 ], which is in accordance with our results. Sex, age, tumor location, previous EVD placement, previous craniotomy, post-craniotomy hemorrhage, and post-craniotomy meningitis were found as non-significant risk factors for revision in adult brain tumor patients [ 15 ]. Further studies are needed to clarify the underlying cause of relatively high shunt failure rate in adult brain tumor patients with either PVs or NPVs.…”