Characteristics of shunt failure in 38,095 adult shunt insertion surgeries: a systematic review and meta-analysis.

Autor:	Isaacs AM; 1Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.; 2Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee., Yang R; 1Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada., Cadieux M; 3Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri., Ben-Israel D; 1Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada., Sader N; 1Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada., Opoku-Darko M; 8Department of Neurosurgery, Altru Health, Grand Forks, North Dakota., Frizon L; 9Department of Neurosurgery, Hospital Marcelino Champagnat, Brazil; and., Yong H; 5Division of Neurology, Department of Clinical Neuroscience, University of Calgary, Alberta, Canada., Premji Z; 6Libraries, University of Victoria, British Columbia, Canada., Nagel S; 4Department of Neurosurgery, Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio.; 7Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.; 10Adult Hydrocephalus Clinical Research Network, Data Coordinating Center, University of Utah, Salt Lake City, Utah., Hamilton MG; 1Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.; 10Adult Hydrocephalus Clinical Research Network, Data Coordinating Center, University of Utah, Salt Lake City, Utah.
Jazyk:	angličtina
Zdroj:	Neurosurgical focus [Neurosurg Focus] 2023 Apr; Vol. 54 (4), pp. E2.
DOI:	10.3171/2023.1.FOCUS22637
Abstrakt:	Objective: The management of excess CSF in patients with hydrocephalus typically requires using a shunt to divert CSF. Unfortunately, there is a high rate of shunt failure despite improvements in device components and insertion techniques. Reoperation is frequently necessary, which contributes to patient harm and increased healthcare costs. While factors affecting shunt failure are well defined in the pediatric population, information regarding adults is lacking. The authors undertook a systematic review and meta-analysis to determine how shunt failure in the adult population is reported and investigated the etiologies of shunt failure. Methods: This review is reported according to PRIMSA and utilized the MEDLINE, Embase, and Google Scholar databases. Abstracts were screened by two independent reviewers, and data were extracted in duplicate by two independent reviewers. Statistical analyses were performed using SPSS and Stata. Results: The pooled rates of shunt failure were 10% (95% CI 5%-15%) in studies with a mean follow-up time of less than 1 year, 12% (95% CI 8%-14%) with a follow-up time between 1 and 2 years, and 32% in studies with a follow-up time of 2 years or greater (95% CI 19%-43%). The pooled rate of failure was 17% across all studies. The most common cause of shunt failure was obstruction at 3.0% (95% CI 2%-4%), accounting for 23.2% of shunt failures. Infection was the second most common at 2.8% (95% CI 2%-3%), accounting for 22.5% of shunt failures. The most common location of shunt failure was the distal catheter, with a failure rate of 4.0% (95% CI 3%-5%), accounting for 33.4% of shunt failures. The definition of shunt failure was heterogeneous and varied depending on institutional practices. The combination of symptoms with either CT or MRI was the most frequently reported method for assessing shunt failure. Conclusions: Important variation regarding how to define, investigate, and report shunt failure was identified. The overall shunt failure rate in adults is at least 32% after 2 years, which, while lower than that typically reported in the pediatric population, is significant. The most common causes of shunt failure in adults are infection and obstruction. The most common site of failure occurred at the distal catheter, highlighting the need to develop strategies to both report and mitigate distal shunt failure in adult shunt patients.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu