Department of Neurosurgery, Bristol Royal Hospital for Children, Bristol, UK.
Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
Neurosurg Rev. 2022 Feb;45(1):479-490. doi: 10.1007/s10143-021-01549-7. Epub 2021 Apr 27.
Risks and survival times of ventriculoperitoneal (VP) shunts implanted due to hydrocephalus after craniotomies for brain tumors are largely unknown. The purpose of this study was to determine the overall timing of VP shunting and its failure after craniotomy for brain tumors in adults. The authors also wished to explore risk factors for early VP shunt failure (within 90 days). A population-based consecutive patient cohort of all craniotomies for intracranial tumors leading to VP shunt dependency in adults (> 18 years) from 2004 to 2013 was studied. Patients with pre-existing VP shunts prior to craniotomy were excluded. The survival time of VP shunts, i.e., the shunt longevity, was calculated from the day of shunt insertion post-craniotomy for a brain tumor until the day of shunt revision requiring replacement or removal of the shunt system. Out of 4774 craniotomies, 85 patients became VP shunt-dependent (1.8% of craniotomies). Median time from craniotomy to VP shunting was 1.9 months. Patients with hydrocephalus prior to tumor resection (N = 39) had significantly shorter time to shunt insertion than those without (N = 46) (p < 0.001), but there was no significant difference with respect to early shunt failure. Median time from shunt insertion to shunt failure was 20 days (range 1-35). At 90 days, 17 patients (20%) had confirmed shunt failure. Patient age, sex, tumor location, primary/secondary craniotomy, extra-axial/intra-axial tumor, ventricular entry, post-craniotomy bleeding, and infection did not show statistical significance. The risk of early shunt failure (within 90 days) of shunts after craniotomies for brain tumors was 20%. This study can serve as benchmark for future studies.
脑肿瘤开颅术后并发脑积水行脑室-腹腔（VP）分流术的风险和生存时间在很大程度上尚不清楚。本研究旨在确定成人脑肿瘤开颅术后 VP 分流术的总体时机及其失败时间。作者还希望探讨早期 VP 分流术失败（90 天内）的危险因素。该研究纳入了 2004 年至 2013 年间所有因颅内肿瘤导致成人（>18 岁）VP 分流依赖而行 VP 分流术的连续患者队列。排除了开颅术前存在 VP 分流的患者。VP 分流的生存时间，即分流管的使用寿命，从脑肿瘤开颅术后放置分流管的那一天开始计算，直到需要更换或移除分流系统的分流管修复那一天。在 4774 例开颅术中，85 例患者成为 VP 分流依赖者（开颅术的 1.8%）。从开颅术到 VP 分流的中位时间为 1.9 个月。与肿瘤切除前无脑积水的患者（N=46）相比，肿瘤切除前有脑积水的患者（N=39）放置分流管的时间明显缩短（p<0.001），但早期分流失败无显著差异。从分流管插入到分流管失效的中位时间为 20 天（范围为 1-35 天）。90 天时，17 名患者（20%）确认分流失败。患者年龄、性别、肿瘤位置、原发性/继发性开颅术、颅外/颅内肿瘤、脑室入路、开颅术后出血和感染与统计学意义无关。脑肿瘤开颅术后 VP 分流的早期（90 天内）失败风险为 20%。本研究可为未来研究提供基准。
