title: Different origins of hydrocephalus lead to different shunt revision rates.
abstract: BACKGROUND
  Hydrocephalus (HC) occurs due to multiple origins. Time course and dynamic of HC and its therapies differ between underlying pathologies. Different revision rates due to the type of HC are expected. Though hydrocephalus is known to be a life time condition, the lack of shunt malfunction years or decades after initial shunt insertion raises the hope of a superfluous shunt.
  
  
  METHODS
  We conducted a retrospective survey of our OR-database during a 10 year period. All newly inserted shunt systems and subsequent shunt revisions are recorded according to quantity and time point. All patients were subdivided according their aetiology of HC.
  
  
  RESULTS
  260 patients were eligible with a follow-up of 4.5 years. Subgroups were: 90 patients with NPH, 76 patients with posthaemorrhagic and 16 patients had posttraumatic HC. 22 received a shunt as a consequence of a tumour, 41 were children and 15 for other causes. Overall revision rate was 39.5%. During the first 6 months 55.6%, 57.9% and 75% of patients with NPH, posthaemorrhagic and posttraumatic HC had revisions. In contrast only 38.1% of children and 20% of tumour cases required early revision.
  
  
  CONCLUSIONS
  Two different patterns of revision are evident: mainly early revisions in morphologically stable diseases such as posthaemorrhagic, posttraumatic and NPH and predominantly late revisions in changing organisms such as children and tumour patients. The conception HC may be transient because of a lack of late revisions cannot be supported by this data.
authors.affiliation: Department of Neurosurgery, Klinikum Kassel, Kassel, Germany. Electronic address: stefaniekaestner@aol.com.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Kaestner
authors.affiliation: Applied Statistics, Department 05, University of Kassel, Kassel, Germany.
authors.forename: Manuela
authors.initials: M
authors.lastname: Poetschke
authors.affiliation: Department of Neurology, Klinikum Kassel, Kassel, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Roth
authors.affiliation: Department of Neurosurgery, Klinikum Kassel, Kassel, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Deinsberger
mesh_terms: D000328:Adult; D002648:Child; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt / Q000706:statistics & numerical data*
keywords: Revision rate; Shunt failure; Ventriculoperitoneal shunt