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Multicenter Study
. 2019 Jul;90(7):747-754.
doi: 10.1136/jnnp-2018-319927. Epub 2019 Mar 25.

Current epidemiology of cerebrospinal fluid shunt surgery in the UK and Ireland (2004-2013)

Rocío Fernández-Méndez  1   2 , Hugh K Richards  3   2 , Helen M Seeley  3   2 , John D Pickard  3   2   4 , Alexis J Joannides  3   2   4 ; UKSR collaborators
Collaborators, Affiliations
Multicenter Study

Current epidemiology of cerebrospinal fluid shunt surgery in the UK and Ireland (2004-2013)

Rocío Fernández-Méndez et al. J Neurol Neurosurg Psychiatry. 2019 Jul.

Abstract

Objectives: To determine current epidemiology and clinical characteristics of cerebrospinal fluid (CSF) shunt surgery, including revisions.

Methods: A retrospective, multicentre, registry-based study was conducted based on 10 years' data from the UK Shunt Registry, including primary and revision shunting procedures reported between 2004 and 2013. Incidence rates of primary shunts, descriptive statistics and shunt revision rates were calculated stratified by age group, geographical region and year of operation.

Results: 41 036 procedures in 26 545 patients were submitted during the study period, including 3002 infants, 4389 children and 18 668 adults. Procedures included 20 947 (51.0%) primary shunt insertions in 20 947 patients, and 20 089 (49.0%) revision procedures. Incidence rates of primary shunt insertions for infants, children and adults were 39.5, 2.4 and 3.5 shunts per 100 000 person-years, respectively. These varied by geographical subregion and year of operation. The most common underlying diagnoses were perinatal intraventricular haemorrhage (35.3%) and malformations (33.9%) in infants, tumours (40.5%) and malformations (16.3%) in children, and tumours (24.6%), post-haemorrhagic hydrocephalus (16.2%) and idiopathic normal pressure hydrocephalus (14.2%) in adults. Ninety-day revision rates were 21.9%, 18.6% and 12.8% among infants, children and adults, respectively, while first-year revision rates were 31.0%, 25.2% and 17.4%. The main reasons for revision were underdrainage and infection, but overdrainage and mechanical failure continue to pose problems.

Conclusions: Our report informs patients, carers, clinicians, providers and commissioners of healthcare, researchers and industry of the current epidemiology of shunting for CSF disorders, including the potential risks of complications and frequency of revision.

Keywords: CSF shunting; Epidemiology; Neurosurgery; Registry.

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Conflict of interest statement

Competing interests: The UKSR is supported by annual subscription fees from each participating institution. Support for a research fellowship program has been established by industry, who receive data on the performance and usage of their own products to facilitate their post-marketing surveillance. The UK Shunt Registry has complete independence over data collection, analysis and publication. AJJ is supported by an NIHR academic clinical lectureship award. JDP was an NIHR Senior Investigator (2009–2014) and is Honorary Clinical Director of the NIHR Brain Injury Health Technology Co-operative (2012–2017), now MedTech Co-operative (2018–2023). The registry has responsibilities to the Society of British Neurological Surgeons and the Medicines and Healthcare products Regulatory Agency.

Figures

Figure 1
Figure 1
Absolute number (top left), distribution by type (primary or revision) (top right) and incidence (bottom) of yearly shunt procedures submitted to the UK Shunt Registry, by age group (infants, children and adults).
Figure 2
Figure 2
Mean incidence of reported primary shunt insertions between 2004 and 2013 (per 100 000 person-years), by region of patients’ residence and age group (infants, children and adults).
Figure 3
Figure 3
Age frequency distribution at primary shunt insertion in infants (1 year old), by sex and underlying diagnostic group. IIH, idiopathic intracranial hypertension; iNPH, idiopathic normal pressure hydrocephalus; IVH, intraventricular haemorrhage.
Figure 4
Figure 4
Age frequency distribution at primary shunt insertion in children (1 to <17 years old), by sex and underlying diagnostic group. IIH, idiopathic intracranial hypertension; iNPH, idiopathic normal pressure hydrocephalus; IVH, intraventricular haemorrhage.
Figure 5
Figure 5
Age frequency distribution at primary shunt insertion in adults (≥17 years old), by sex and underlying diagnostic group. IIH, idiopathic intracranial hypertension; iNPH, idiopathic normal pressure hydrocephalus; IVH, intraventricular haemorrhage.
See this image and copyright information in PMC

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