title: Multiple shunt system revisions in patients with hydrocephalus - causes, effects, regularities and prognostic factors.
abstract: OBJECTIVE
  Hydrocephalus in its various forms constitutes one of the major problems in neurosurgery. All neurosurgeons struggle with shunt malfunctions and their complications. Clinical experience suggests that there may exist a definite constellation of clinical features associated with higher risk of shunt malfunction. The aim of this study was to elucidate this issue based on our clinical experience.
  
  
  METHODS
  Retrospective analysis of the clinical database was used to assess shunt procedures performed between 1980 and 2005 in 1860 children and adolescents with active hydrocephalus as the main or associated problem at admission. Overall, 2197 procedures were performed and the analysis included only patients who were treated surgically at least 3 times (n=106). Patients' age ranged from one day to 22 years.
  
  
  RESULTS
  Recurrent shunt malfunctions were mostly associated with non-modifiable parameters (e.g. age <1 year, porencephaly, benign tectal mass and slit ventricle syndrome). Modifiable parameters (e.g. type of shunt or surgical technique) had no significant influence on treatment outcome.
  
  
  CONCLUSIONS
  1. The proportion of patients who require multiple (> or = 3) shunt revisions is small. 2. Higher risk of shunt malfunction and its subsequent revisions is associated with age below 1 year at first shunt insertion and aetiology of hydrocephalus resulting in severe shunt dependence. 3. Time interval between consecutive shunt revisions does not exceed 1 year in most cases.
authors.affiliation: Oddział Neurochirurgii IPCZD, Al. Dzieci Polskich 20, 04-736 Warszawa, Poland. pmdaszkiewicz@o2.pl
authors.forename: Paweł
authors.initials: P
authors.lastname: Daszkiewicz
authors.forename: Sławomir
authors.initials: S
authors.lastname: Barszcz
mesh_terms: D000293:Adolescent; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D008297:Male; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors