The Preventable Shunt Revision Rate: A Multicenter Evaluation

Dave, Pooja; Venable, Garrett T.; Jones, Tamekia L.; Khan, Nickalus R.; Albert, Gregory W.; Chern, Joshua J.; Wheelus, Jennifer; Governale, Lance S.; Huntoon, Kristin; Maher, Cormac O.; Bruzek, Amy K.; Mangano, Francesco T.; Mehta, Vivek; Beaudoin, Wendy; Naftel, Robert P.; Basem, Jade; Whitney, Anna; Shimony, Nir; Rodríguez, L. F.; Vaughn, Brandy; Klimo, Paul

doi:10.1093/neuros/nyy263

Cited by 21 publications

(12 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Notably, only 4 of these 17 patients had hydrocephalus before craniotomy, while the remaining 13 patients presented without hydrocephalus before craniotomy for brain tumor (Table 2). In the literature, shunt-failure rates range from 16.9 to 28.8% at 3 months [4,7,36] and 9.17-77.3% at 6 months [7,8,[23][24][25]36] with median shunt-survival times from 22.5 days up to 5.2 years [23,25,35]. However, most of these studies have not been conducted of brain tumor patients as a separate cohort.…”

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 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

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: Introductionmentioning

confidence: 99%

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

“…Shunt insertion for CSF diversion becomes one of the procedures most prone to failure. Some studies showed the incidence of shunt failure of around 30–51% in the 1 st year after the shunt insertion[ 2 , 3 , 7 , 10 , 13 ] This number is almost 2-fold higher than the incidence of shunt revision during the first 12 months follow-up after the shunt procedure in our center which was 18.3%. There are several factors that might be involved in this difference including the nonexistence of a shunt registry in Indonesia compared to the developed countries where the shunt registry is available to accommodate the sustainable follow-up for patients who had a shunt procedure.…”

Section: Discussionmentioning

confidence: 79%

“…[ 13 , 16 ] The increasing age showed significant association as protective factor in both univariate and multivariate analyses as each additional year was associated with 20% of decreasing the risk of shunt failure leading to shunt revision. [ 3 ]…”

Section: Discussionmentioning

confidence: 99%

“…Studies showed that the incidence of shunt failure is approximately 30–51% in the 1 st year after shunt placement. [ 2 , 3 , 7 , 10 , 13 ] Despite the developments in technology and design, shunt failure remains to be a problem. The causes of revision are infection, shunt obstruction, mechanical shunt failure, over-drainage shunt, and distal catheter site-specific failures.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pediatric shunt revision analysis within the first year of shunt placement: A single center experience

Azzam

Wathoni

Suryaningtyas

et al. 2021

Surgical Neurology International

View full text Add to dashboard Cite

Background: Hydrocephalus is a common problem in neurosurgery with shunt placement remains the mainstay of the management. However, shunt placement generally requires following surgical procedures, including shunt revision. Despite the recent developments, the incidence of shunt failure remains high, approximately 30–51% in the 1st year following the shunt placement. Methods: An observational retrospective study of pediatric neurosurgery patients whom underwent CSF shunting procedure, both primary and repeated VPS, VAS, CPS, and subdural-peritoneal shunt procedures between January 2018 and May 2019. The patients were observed for 12 months for potential complication requiring shunt revision following the shunt placement. Results: A total of 142 patients underwent shunt placement. The shunt revision within 12 months was found in 26 patients (18.3%), 25 cases were VPS (96.2%) and one case was CPS (3.8%). The mean period of time between shunt placement to shunt revision was 3.96 months. Age of under 6 months old during the shunt placement showed significantly higher risk for shunt revision (RR 2.32 CI 1.13–4.74, P = 0.018). The most common diagnosis requiring shunt revision was congenital anomaly (16 cases, 61.5%). The most common cause of revision was shunt malfunction, with 21 cases (80.8%) followed by infected shunt with 5 cases (19.2%). Conclusion: The 1st year observation showed relatively high rate for shunt revision. The patient underwent shunt procedure should be regularly followed up in long period for better evaluation of the outcome. The application of shunt registry in some countries appears to be efficient and beneficial for sustainable follow-up in patients underwent shunt placement.

show abstract

Association between ventricular shunt catheter calcifications and the development of shunt fracture

et al. 2019

View full text Add to dashboard Cite

The Preventable Shunt Revision Rate: A Multicenter Evaluation

Abstract: PSRR is variable across institutions, but can be 50% or higher. While the PSRR may never reach zero, this study demonstrates that overall about a third of early failures are potentially preventable.

Cited by 21 publications

References 32 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

Pediatric shunt revision analysis within the first year of shunt placement: A single center experience

Association between ventricular shunt catheter calcifications and the development of shunt fracture

Contact Info

Product

Resources

About