title: Rate and Risk Factors for Shunt Revision in Pediatric Patients with Hydrocephalus-A Population-Based Study.
abstract: BACKGROUND
  Ventriculoperitoneal shunt (VPS) is a common treatment for patients with hydrocephalus (HC). VPS is associated with complications that may lead to shunt revisions. We studied the surgical outcome of pediatric patients with HC in a population-based setting.
  
  
  METHODS
  The medical charts and imaging findings of 80 patients ≤16 years old who required VPS secondary to HC were studied.
  
  
  RESULTS
  Mean age at time of initial shunt placement was 3.2 years (SD 4.5) and mean follow-up time was 3.3 years (SD 2.9); 57% of patients were male. Half of patients underwent shunt revision with mean time to first revision of 8 months. Patients ≤6 months old had a higher shunt revision rate compared with patients >6 months old (P < 0.001). The most common causes of HC requiring VPS were tumors (27.5%), congenital defects (22.5%), and intraventricular hemorrhage (19%). Revision rates in the intraventricular hemorrhage and congenital defects groups were 67% (P = 0.017) and 72% (P = 0.016) compared with 32% in the tumor group. Programmable valves (56%) were more common than nonprogrammable valves, but there was no significant difference in shunt survival (P = 0.632). The mean biparietal measurement change between preoperative and postoperative images was +0.9 mm in the no revision group and +6.6 mm in the revision group (P = 0.003).
  
  
  CONCLUSIONS
  Half of patients with shunts required revision. Age ≤6 months and intraventricular hemorrhage and congenital defects etiologies of HC were associated with increased risk for shunt revision. Most revisions were done during the first year after the initial VPS.
authors.affiliation: Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Joona
authors.initials: J
authors.lastname: Tervonen
authors.affiliation: Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Ville
authors.initials: V
authors.lastname: Leinonen
authors.affiliation: Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Juha E
authors.initials: JE
authors.lastname: Jääskeläinen
authors.affiliation: Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Susanna
authors.initials: S
authors.lastname: Koponen
authors.affiliation: Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland. Electronic address: terhi.j.huttunen@kuh.fi.
authors.forename: Terhi J
authors.initials: TJ
authors.lastname: Huttunen
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D011159:Population Surveillance / Q000379:methods; D012042:Registries; D012086:Reoperation / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D017287:Ventriculoperitoneal Shunt / Q000639:trends*
keywords: Hydrocephalus; Pediatric; Population-based; Revisions; Shunting