Chirurgische Revisionen bei Shunt-Komplikationen: eine umfassende monozentrische Analyse

Cerebrospinal fluid (CSF) shunt implantation is a common neurosurgical procedure. However, complications requiring surgical revision pose a considerable challenge. This study aims to analyze key factors contributing to these complications.

We analyzed diseases and causes linked to shunt complications necessitating revision surgeries. Factors included initial diagnosis, number of surgeries, shunt type, dysfunction causes, and valve longevity. Only adult patients were included.

Between 2018 and 2024, 164 adult patients (83 female) underwent revision surgeries. The median age at first shunt implantation was 55.9 years (range, 0–84.3). The most common initial diagnosis leading to shunt implantation was subarachnoid hemorrhage (SAH) (25.6%), followed by intracerebral hemorrhage (ICH) (19.5%), tumor-associated hydrocephalus (13.4%) and normal pressure hydrocephalus (10.4%). A total of 238 revision surgeries were performed. Shunt infection was the most common cause (21.5%), followed by ventricular catheter malposition/displacement (13.4%), valve dysfunction (12.6%) and peripheral catheter malposition/displacement (9.6%). A rare complication involving dislocation of the pressure control cam of a Codman-Hakim programmable valve was identified in 4 cases (1.6%) via x-ray. Most revisions occurred in SAH (42 surgeries) and ICH (32 surgeries) patients (p<0.001). The median time to first revision was 45 days for SAH and 31.5 days for ICH. Ventriculoperitoneal shunts were initially used in 92.2% of patients. Shunt conversion was performed in 29 patients (17.7%), mostly from ventriculoperitoneal to ventriculoatrial (86.2%). Notably, three out of four patients with pseudotumor cerebri ultimately required ventriculoatrial shunts due to abdominal complications. Codman-Hakim programmable valves were initially used in 79.8% of patients. Valve replacement due to dysfunction occurred in 50 patients (30.7%), with SAH (24%) and ICH (20%) as leading diagnoses (p=0.016). Shunt explantation predominantly due to infection without severe consequences occurred in 24 patients (14.6%), mainly in SAH and ICH.

CSF shunt revision surgeries are a frequent aspect of neurosurgical practice. SAH and ICH emerged as the most common initial diagnoses associated with complications. Shunt infection remains the leading cause of revision, and rare complications, such as Codman-Hakim valve pressure control cam dislocation, underline the need for meticulous follow-up and management.