title: Shunt failure in adult hydrocephalus: flow-controlled shunt versus differential pressure shunts--a cooperative study in 289 patients.
abstract: BACKGROUND
  In order to assess the efficiency of flow-controlled shunts in reducing shunt failure in the treatment of adult hydrocephalus (with a special focus on overdrainage complications), a series of 289 patients was analyzed through a retrospective and comparative study performed in three neurosurgical departments.
  
  
  METHODS
  A group of 142 adult patients suffering from hydrocephalus were operated on using a conventional differential pressure (DP) shunt and compared with a group of 147 adult patients operated on using flow-controlled (FC) system (Orbis-Sigma, Cordis). Only the first complication, which required a surgical revision within the first 2 years after shunt implantation, was taken into account for each patient and analyzed using life-table methods.
  
  
  RESULTS
  The actuarial risk of shunt infection in the two groups is respectively 8.3% and 10.9% at 1 year (nonsignificant difference). The actuarial risk of mechanical complications at 1 year is 38% for the DP patients and 10% for the FC patients (p = 0.0001); this difference is largely due to a decrease of complications related to overdrainage phenomenon (14/142 subdural collections were observed in the DP group versus 1/147 in the FC group) (p = 0.0001).
  
  
  CONCLUSIONS
  The conclusion of this cooperative and retrospective study is that the use of a flow-controlled system decreases the risk of mechanical complications related to the hydrodynamic properties of the shunts used in the treatment of adult hydrocephalus, especially those related to overdrainage.
authors.affiliation: Service de Neurochirurgie, CHU Henri Mondor, Creteil, France.
authors.forename: P
authors.initials: P
authors.lastname: Decq
authors.forename: J L
authors.initials: JL
authors.lastname: Barat
authors.forename: E
authors.initials: E
authors.lastname: Duplessis
authors.forename: C
authors.initials: C
authors.lastname: Leguerinel
authors.forename: P
authors.initials: P
authors.lastname: Gendrault
authors.forename: Y
authors.initials: Y
authors.lastname: Keravel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies