title: Have we made progress in preventing shunt failure? A critical analysis.
abstract: OBJECTIVE
  The goal of this study was to determine whether failure rates of hydrocephalus shunts have fallen over the years as a result of experience or technical improvements.
  
  
  METHODS
  A structured search was performed of the English language literature for case series reporting failure rates after shunt insertion. A metaanalytic model was constructed to pool data from multiple studies and to analyze failure rates statistically for temporal trends. Separate models were used for children (< 17 years old) and adults.
  
  
  RESULTS
  In children, the shunt failure rate was 31.3% for the 1st year and 4.5% per year thereafter. There were no significant changes in either rate over time. Although 1st-year failure rates in adults have fallen slightly over time, late failure rates have risen.
  
  
  CONCLUSIONS
  Progress in preventing shunt failures has not been made over the last several decades. Any improvements made in shunt materials or insertion techniques have been overshadowed by biological and other factors.
authors: Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19106, USA. sherman.stein@uphs.upenn.edu
authors: Sherman C
authors: SC
authors: Stein
authors: Wensheng
authors: W
authors: Guo
mesh_terms: D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology* / Q000601:surgery*; D007223:Infant; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000706:statistics & numerical data*; D017211:Treatment Failure