Long-Term Outcomes of Ventriculoperitoneal Shunt Surgery in Patients with Hydrocephalus

OBJECTIVE: Ventriculoperitoneal (VP) shunt surgery is the predominant mode of therapy for patients with hydrocephalus. However, it has potential complications that may require multiple surgical procedures during a patient's lifetime. The objective of this study is to review our long-term experience and evaluate the risk factors for VP shunt failure after initial shunt surgery and after subsequent revisions. METHODS: Patients who underwent VP shunt surgery for hydrocephalus were included. Medical charts, operative reports, imaging studies, and clinical follow-up evaluations were reviewed and analyzed retrospectively. RESULTS: A total of 1015 patients with the median age of 41.6 (range, 0-90.3) years at the time of VP shunt surgery were included. The mean and median follow up was 9.2 and 6.5 years, respectively. Adult patients (>= 17 years) accounted for 70.0% of the patients. The overall shunt failure rate requiring shunt revision(s) was 46.3%, and the majority of shunt revisions occurred during the first 6 months after shunt placement. The shunt revision rate was significantly greater in pediatric (<17 years) than in adult (>17 years) patients (78.2% vs. 32.5%, P < 0.001). Age at the time of shunt surgery, previous treatments to shunt surgery, etiology of hydrocephalus, and hydrocephalus type were independently associated with the incidence of shunt revision. Age at shunt placement and sex were significantly associated with multiple shunt revisions. Among populations with at least one shunt revision, pediatric patients had significantly lower shunt survival rate and shorter median time to subsequent shunt revision than the adult (>17 years) patients; male patients had greater odds for multiple revisions than female patients. CONCLUSION: The findings of the study indicate that age at shunt placement, etiology of hydrocephalus, type of hydrocephalus, and previous treatments before shunt surgery were independently significantly associated with the shunt survival. Prospective controlled studies are required to address the observed associations between the risk factors and incidence of shunt revisions in these patients.