title: Ventriculoperitoneal shunt surgery and the incidence of shunt revision in adult patients with hemorrhage-related hydrocephalus.
abstract: OBJECTIVE
  Ventriculoperitoneal shunt surgery remains the most widely accepted neurosurgical procedure for the management of hydrocephalus. However, shunt failure and complications are common and may require multiple surgical procedures during a patient's lifetime. The purpose of this study is to evaluate the ventriculoperitoneal shunt surgery and the incidence of shunt revision in adult patients with hemorrhage-related hydrocephalus.
  
  
  METHODS
  Adult patients who underwent ventriculoperitoneal shunt placement for hemorrhage-related hydrocephalus from October 1990 to October 2009 were included in this study. Medical charts, operative reports, imaging studies, and clinical follow-up evaluations were reviewed and analyzed retrospectively.
  
  
  RESULTS
  A total of 133 adult patients with the median age of 54.5 years were included. Among patients, 41% were males, and 62% Caucasians. The overall shunt revision rate was 51.9%. The shunt revision rate within the first 6 months after the initial placement of ventriculoperitoneal shunts was 45.1%. The median time to first shunt revision was 0.50 (95% CI, 0.24-9.2) months. No significant association was observed between perioperative variables (gender, ethnicity, hydrocephalus type, or hemorrhage type) and the shunt revision rate in these patients. Major causes of shunt revision include infection (3.6%), overdrainage (7.6%), obstruction (4.8%), proximal shunt complication (7.6%), distal shunt complication (3.6%), old shunt dysfunction (6.8%), valve malfunction (10.0%), externalization (3.6%), shunt complication (12.0%), shunt adjustment/replacement (24.0%) and other (16.4%).
  
  
  CONCLUSIONS
  Although ventriculoperitoneal shunting remains to be the treatment of choice for adult patients with post hemorrhage-related hydrocephalus, a thorough understanding of predisposing factors related to the shunt failure is necessary to improve treatment outcomes.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States. kreddy_usa@yahoo.com
authors.forename: G Kesava
authors.initials: GK
authors.lastname: Reddy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000601:surgery*; D020300:Intracranial Hemorrhages / Q000150:complications*; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications; D016019:Survival Analysis; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000706:statistics & numerical data*; D055815:Young Adult