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LOWER INCIDENCE OF REOPERATION WITH LONGER SHUNT SURVIVAL WITH ADULT VENTRICULOPERITONEAL SHUNTS PLACED FOR HEMORRHAGERELATED HYDROCEPHALUS

Hoh, Brian L. M.D.; Lang, Shih-Shan M.D.; Ortiz, Michael V. B.S.; Chi, Yueh-Yun Ph.D.; Lewis, Stephen B. M.D.; Pincus, David W. M.D., Ph.D.

doi: 10.1227/01.NEU.0000319527.34738.9D
Clinical Studies

OBJECTIVE: The incidence of reoperation for ventriculoperitoneal shunts (VPS) in adults, although lower than in pediatric patients, is not insignificant. We hypothesize that adult VPS placed for hemorrhage-related hydrocephalus have a lower incidence of reoperation than those placed for other types of hydrocephalus.

METHODS: We retrospectively reviewed all adult (≥ 20 yr) VPS initially placed from February 2001 to August 2006 at the University of Florida. We determined the incidence and time interval to reoperation. Follow-up was conducted by telephone interview and review of medical records.

RESULTS: A total of 286 adult VPS were initially placed: 96 (34%) hemorrhage and 190 (66%) nonhemorrhage. A total of 15 (16%) hemorrhage patients underwent 22 shunt reoperations, compared with 50 (27%) nonhemorrhage patients who underwent 82 shunt reoperations (P = 0.0316). A Poisson regression analysis of the number of reoperations, factoring hemorrhage, age, and sex, demonstrated a significantly lower incidence of reoperation in hemorrhage patients (P = 0.0900). A Cox proportional hazards model analysis of time to first reoperation, factoring hemorrhage, age, and sex, demonstrated a significantly longer shunt survival in hemorrhage patients (P = 0.0404).

CONCLUSION: Adult VPS placed for hemorrhage-related hydrocephalus have a significantly lower incidence of reoperation and significantly longer shunt survival. This result may be related to an incidence of transient shunt dependency in patients with hemorrhage-related hydrocephalus. However, the precise mechanism remains unclear.

Department of Neurological Surgery, University of Florida College of Medicine, Gainesville, Florida (Hoh) (Lewis) (Pincus)

Department of Neurological Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (Lang)

University of Florida College of Medicine, Gainesville, Florida (Ortiz) (Chi)

Reprint requests: Brian L. Hoh, M.D., Department of Neurological Surgery, University of Florida College of Medicine, PO Box 100265, Gainesville, FL 32610. Email: brian.hoh@neurosurgery.ufl.edu

Received, October 22, 2007.

Accepted, April 18, 2008.

Copyright © by the Congress of Neurological Surgeons