The workhorse of hydrocephalus management: a decade of shunt surgery in a UK neurosurgical unit

OBJECTIVES: Shunt surgery is a mainstay treatment for hydrocephalus. However, it is often fraught with complications. This study aims to describe outcomes of primary and revisional shunts and identify contributing factors to shunt survivals. METHODS: This is a single-centre, retrospective, observational study of all adult patients who have undergone a shunt surgery in the West of Scotland between 2013 and 2022. The primary outcome measures were time to and cause of shunt failure. Factors associated with outcome were identified, and comparative analyses were conducted between primary and revisional shunts. RESULTS: A total of 969 shunt surgeries were performed in 519 patients. Mean age of patients having a shunt inserted was 44.3 years. 50% of cases involved two surgeons, and the average duration of surgery was 1.03 hours. The 3 main indications for shunting were congenital malformations (200 cases, 21%), mass lesions (191 cases, 20%) and post-haemorrhagic vascular causes (156 cases, 16%). Ventriculoperitoneal shunts (772 cases, 82%) were the most common shunt inserted, followed by lumboperitoneal shunts (113 cases, 12%) and ventriculopleural shunts (45 cases, 4.8%). 609 (65%) cases had a fixed pressure valve, while 245 (26%) had a programmable valve. 32% (258) of proximal catheters were placed with assistance (ultrasound or neuro-navigation guidance). The one-year shunt survival rate was 60.7%. The median shunt survival was 652 days. The most common reasons for shunt revision were mechanical obstruction (232 cases, 40%), shunt infection (85 cases, 15%), and shunt disconnection, fracture, or kinking (74 cases, 13%). 66 cases (67%) of shunt infections had a positive CSF culture. CONCLUSIONS: This study presented a contemporary overview of shunt surgeries in treating hydrocephalus in a tertiary UK neurosurgical centre. The study analysed patient demographics, clinical indications, intraoperative variables, and post-operative outcomes over a 10-year period, providing up-to-date, real-world evidence on shunt practice in a range of neurosurgical patients.