Long-term follow-up of shunting therapy

Ventricular CSF shunting surgery has changed the overall outcome figures fo r hydrocephalic patients over the past three decades. The factors that have improved the outcome are evolution of the shunt systems, improvement of th e surgical environment and use of potent antibiotics, technological advance s in brain imaging, and refinements in the assessment of cognitive and func tional outcomes and of actuarial statistical techniques. But the recent lar ge Studies revealed that nearly half of all shunt placements were for revis ion, and there is a low but real percentage of cases in which death and neu rological impairment are related to shunt surgery. The most frequent compli cation was shunt obstruction, followed by infection, disconnection, hematom a and slit ventricle syndrome. This clearly means that the shunt systems an d the techniques in current use involve many problems that have yet to be s olved. To solve these problems, new shunt systems should be developed and c ontinuous efforts at reducing shunt infection should be made. The overall c omplication rate in the authors' series was 31.7%, but we have been able to reduce the complication rate from 37% to 25% by exercising special care fo cused on the surgical environment and techniques. Careful, long-term follow -up using various parameters and proper statistical analysis is another imp ortant factor in improving surgical outcome. Multicenter and international studies will be easier with the development of a network, and it will give us a strong background to treat hydrocephalus.