Shunt Failure—The First 30 Days

Lee, Ryan P.; Thomas, Fridtjof; Dave, Pooja; Lillard, Jock C; Wallace, David A.; Broussard, Austin; Motiwala, Mustafa; Norrdahl, Sebastian; Venable, Garrett T.; Khan, Nickalus R.; Harrell, Camden; Jones, Tamekia L.; Vaughn, Brandy; Gooldy, Tim; Hersh, David S.; Klimo, Paul

doi:10.1093/neuros/nyz379

Cited by 12 publications

(9 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The cause of hydrocephalus had no impact on risk of shunt dysfunction [25]. Conversely, Lee et al reported that EVD placement at index surgery (defined as new shunt or revision for the patient) was not predictive of 30-day shunt failure [28]. However, both of the abovementioned studies were not limited to brain tumor patients only.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, one could expect that patients with earlier VP shunting would have reduced shunt longevity, even though the discrepancy of time to shunting and shunt failure between those with and without prior hydrocephalus was comparable (Table 2 ). Although high protein content from certain tumor types has been associated with hydrocephalus [ 11 , 32 ], other factors such as hemoventriculi at the time of shunt surgery [ 28 ], male sex, and benign tumors have been associated with shorter shunt survival [ 36 ]. Lastly, Reddy et al [ 36 ] reported that females had significantly longer shunt-survival rates ( p < 0.001) compared to males; we could not find this association in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Although the main objective of treating hydrocephalus with VP shunts is to establish a permanent CSF diversion, achieving maximum VP shunt survival, defined as time from implantation to its malfunction, still remains challenging. Numerous studies have been published on postoperative shunting and shunt-survival rates with respect to the pediatric population [16], hemorrhage-related hydrocephalus [28,34], infections [4,8,24,25], shunting related to specific tumor types [3,19], and vascular brain malformations [15]. However, studies on shunt-survival rates and risks leading to shunt failure with respect to brain tumors remain scarce.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk of early failure of VP shunts implanted for hydrocephalus after craniotomies for brain tumors in adults

2021

View full text Add to dashboard Cite

Risks and survival times of ventriculoperitoneal (VP) shunts implanted due to hydrocephalus after craniotomies for brain tumors are largely unknown. The purpose of this study was to determine the overall timing of VP shunting and its failure after craniotomy for brain tumors in adults. The authors also wished to explore risk factors for early VP shunt failure (within 90 days). A population-based consecutive patient cohort of all craniotomies for intracranial tumors leading to VP shunt dependency in adults (> 18 years) from 2004 to 2013 was studied. Patients with pre-existing VP shunts prior to craniotomy were excluded. The survival time of VP shunts, i.e., the shunt longevity, was calculated from the day of shunt insertion post-craniotomy for a brain tumor until the day of shunt revision requiring replacement or removal of the shunt system. Out of 4774 craniotomies, 85 patients became VP shunt-dependent (1.8% of craniotomies). Median time from craniotomy to VP shunting was 1.9 months. Patients with hydrocephalus prior to tumor resection (N = 39) had significantly shorter time to shunt insertion than those without (N = 46) (p < 0.001), but there was no significant difference with respect to early shunt failure. Median time from shunt insertion to shunt failure was 20 days (range 1–35). At 90 days, 17 patients (20%) had confirmed shunt failure. Patient age, sex, tumor location, primary/secondary craniotomy, extra-axial/intra-axial tumor, ventricular entry, post-craniotomy bleeding, and infection did not show statistical significance. The risk of early shunt failure (within 90 days) of shunts after craniotomies for brain tumors was 20%. This study can serve as benchmark for future studies.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk of early failure of VP shunts implanted for hydrocephalus after craniotomies for brain tumors in adults

2021

View full text Add to dashboard Cite

show abstract

“…Placement of EVD for treating HC, regardless of timing before, during, or after craniotomy for brain tumor, was not associated with shunt longevity in the long term (Table 3 ). For shorter time periods, other studies have also reported no significant association between EVD placement and shunt failure within 30 days [ 31 ] and 90 days [ 17 ]. However, previous EVD placements and males have been reported to be risk factors for first revision for mechanical dysfunction, although the cause of HC had no impact on risk of shunt dysfunction [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term risk of shunt failure after brain tumor surgery

2021

View full text Add to dashboard Cite

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.

show abstract

“…[3][4][5] The need for reoperation is particularly high within the first 30 days after surgery, with reported rates ranging from 12% to 24%. [6][7][8][9][10] For these reasons, our institution has moved…”

mentioning

confidence: 99%

The low utility of routine cranial imaging after pediatric shunt revision

Hulsbergen

Siddi

McAvoy

et al. 2022

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

OBJECTIVE Postoperative routine imaging is common after pediatric ventricular shunt revision, but the benefit of scanning in the absence of symptoms is questionable. In this study, the authors aimed to assess how often routine scanning results in a change in clinical management after shunt revision. METHODS The records of a large, tertiary pediatric hospital were retrospectively reviewed for all consecutive cases of pediatric shunt revision between July 2013 and July 2018. Postoperative imaging was classified as routine (i.e., in the absence of symptoms, complications, or other direct indications) or nonroutine. Reinterventions within 30 days were assessed in these groups. RESULTS Of 387 included shunt revisions performed in 232 patients, postoperative imaging was performed in 297 (77%), which was routine in 244 (63%) and nonroutine in 53 (14%). Ninety revisions (23%) underwent any shunt-related procedure after postoperative imaging, including shunt reprogramming (n = 35, 9%), shunt tap (n = 10, 3%), and a return to the operating room (OR; n = 58, 15%). Of the 244 cases receiving routine imaging, 241 did not undergo a change in clinical management solely based on routine imaging findings. The remaining 3 cases returned to the OR, accounting for 0.8% (95% CI 0.0%–1.7%) of all cases or 1.2% (95% CI 0.0%–2.6%) of cases that received routine imaging. Furthermore, 27 of 244 patients in this group returned to the OR for other reasons, namely complications (n = 12) or recurrent symptoms (n = 15); all arose after initial routine imaging. CONCLUSIONS The authors found a low yield to routine imaging after pediatric shunt revision, with only 0.8% of cases undergoing a change in management based on routine imaging findings without corresponding clinical findings. Moreover, routine imaging without abnormal findings was no guarantee of an uneventful postoperative course. Clinical monitoring can be considered as an alternative in asymptomatic, uncomplicated patients.

show abstract

Shunt Failure—The First 30 Days

Cited by 12 publications

References 30 publications

Risk of early failure of VP shunts implanted for hydrocephalus after craniotomies for brain tumors in adults

Risk of early failure of VP shunts implanted for hydrocephalus after craniotomies for brain tumors in adults

Long-term risk of shunt failure after brain tumor surgery

The low utility of routine cranial imaging after pediatric shunt revision

Contact Info

Product

Resources

About