Determinants of adult Ventriculoperitoneal Shunt failure: Insights from a large neurosurgical centre

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-06-11 DOI:10.1016/j.clineuro.2025.109013

James Stewart , John Warner-Levy , Sebastian Bate , Catherine McMahon , Dominic Slade , Matthew Bailey

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引用次数: 0

Abstract

Background

Ventriculoperitoneal Shunts (VPS) are commonly inserted and often lifesaving. Complication and failure rates are persistently high. Research to identify risk factors is disproportionately skewed to paediatric VPS and has returned inconsistent results. There has been minimal change in failure rates for decades.

Objectives

To identify modifiable risk factors for adult VPS failure, to identify non-modifiable risk factors which predict future failure, and to describe the timing of failure.

Methods

Single-centre retrospective cohort study reviewing all VPS surgery between December 2021 and December 2023. Minimum of one year follow-up. Data collected included patient demographics, underlying indication for VPS, and technical factors. Univariable and multivariable analysis used to investigate for risk factors for implant failure. Kaplan-Meier plots generated. Modality of failure recorded. We evaluate the use of a post-operative CT based grading system to predict future failure.

Results

202 operations (including 49 revisional surgeries) performed. Average follow-up excluding failed shunts and patients who died was 719 days. No patients died from VPS failure. Shunt survival at one-year was 71.5 %. Average time to failure was 62.48 days. Surgeon experience, use of non-programmable valves, previous permanent CSF diversion surgery for any reason other than insertion of the same VPS, ventricular catheter location, and the presence of a CNS tumour or aqueduct stenosis were significantly associated with failure. Failure was significantly higher after revisional surgery.

Conclusion

We have described the epidemiology of adult VPS failure, identified risk factors for failure, and described factors not associated with failure, guiding decision making and the technical performance of surgery.

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成人脑室-腹膜分流失败的决定因素：来自大型神经外科中心的见解

背景：脑室-腹膜分流术（VPS）通常被置入，通常可以挽救生命。并发症和失败率居高不下。确定风险因素的研究不成比例地倾向于儿科VPS，并且得出了不一致的结果。几十年来，失败率几乎没有变化。目的确定成人VPS衰竭的可改变的危险因素，确定预测未来衰竭的不可改变的危险因素，并描述衰竭的时间。方法单中心回顾性队列研究，回顾2021年12月至2023年12月期间所有VPS手术。至少一年的随访。收集的数据包括患者人口统计、VPS的潜在适应症和技术因素。单变量和多变量分析用于研究种植体失败的危险因素。生成Kaplan-Meier图。记录故障的形式。我们评估使用基于术后CT的分级系统来预测未来的失败。结果共完成202例手术，其中翻修手术49例。排除分流失败和患者死亡的平均随访时间为719天。无患者死于VPS衰竭。分流术一年生存率为71.5% %。平均失效时间为62.48天。外科医生经验、使用非可编程瓣膜、除插入相同VPS外的任何原因的永久性脑脊液转移手术、心室导管位置、存在中枢神经系统肿瘤或导水管狭窄与失败显著相关。翻修手术后的失败率明显更高。结论描述了成人VPS手术失败的流行病学，确定了失败的危险因素，描述了与失败无关的因素，指导了手术的决策和技术性能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.