Rate and risk factors for shunt revision in pediatric patients with hydrocephalus during a 17-year study period: a retrospective, population-based study.

PURPOSE: We studied the surgical outcomes of pediatric hydrocephalus (HC) patients requiring primary cerebrospinal fluid (CSF) diversion surgery with ventriculoperitoneal shunt (VPS) in a retrospective population-based study. METHODS: The medical records of 92 patients under 16 years of age with HC requiring primary VPS were reviewed. Patients with Strata adjustable valve were studied in their own cohort. The rate and the risk factors for shunt revision were analyzed. RESULTS: We found 92 patients treated with primary VPS. Strata adjustable valve shunt was used in 43 patients. The mean age at the time of primary shunt insertion was 3.2 years (SD 4.7 years). The mean follow-up time for shunted patients was 5.9 years (SD 6.8 years), and 5.3 years (SD 5.3 years) for the Strata valve subgroup. The most common etiologies of HC were tumors (29.3%), congenital defects (CD) (21.7%), and intraventricular hemorrhage (IVH) (22.8%) in shunted patients. During the follow-up period, 54.3% of all shunted patients and 48.8% of Strata valve shunted patients underwent at least one revision surgery. The mean time to revision surgery was 1.0 years. Revision rates in the CD group (70%) were higher compared to the tumor group (37%) (P = 0.044). Patients younger than 6 months had higher shunt revision rates than older patients (P = 0.036). CONCLUSIONS: Out of the 92 shunted patients, 54.3% underwent revision surgery, with most revisions occurring within the first year after initial VPS placement. Patient characteristics, such as congenital defects and age under 6 months, were associated with a higher risk for shunt revision. The use of the Strata adjustable valve did not have a statistically significant impact on shunt revision rates.