Child's Nerv Syst (1994) 10:321-327 © Springer-Verlag 1994 Concezio Di Rocco Enrico Marchese Francesco Velardi A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus Cooperative survey of the 1991-1992 Education Committee of the ISPN Received: 3 January 1994 C. Di Rocco (~) . E. Marchese • tv. Velardi Pediatric Section, Institute of Neurosurgery, Catholic University, Largo A. Gemelli, 8, 1-00168 Rome, Italy Abstract The results of an interna- tional multicenter study concerning the first complication of newly im- planted cerebrospinal fluid shunts in nontumoral hydrocephalus are the subject of the present report. The authors have collected infor- mation on 773 cases from four con- tinents. In particular, the following data were evaluated in relation to the general incidence of complica- tions recorded in the first follow-up year: the patient's age at the opera- tion, the etiology of hydrocephalus, the type of CSF shunt device used, and the modality of the surgical procedures. The overall complica- tion rate in the series was 29%. Age and etiology of hydrocephalus appear to play a major role in in- fluencing the complication rate; on the other hand, the choice of a specific CSF shunt device seems to be less important in this respect. Key words Nontumoral hydrocephalus • CSF shunt devices CSF shunt complication Introduction At the invitation of the Education Committee of the ISPN, 38 neurosurgical centers agreed to participate in a cooperative study that aimed to evaluate the causes and respective incidences of the first complications of cere- brospinal fluid (CSF) shunting in patients with nontu- moral hydrocephalus operated on for the first time dur- ing 1991 and followed for at least 1 year. In addition, the study was planned to provide general information about policies of hydrocephalus treatment in neurosurgical centers around the world, e.g., which type of CSF shunt procedure was most frequently used, which shunt devices were selected, and what collateral measures adopted to reduce the risk of shunt failure. Materials and methods A "Prospective Evaluation Form for Hydrocephalus" was sent to all members of the ISPN. Thirty-eight centers agreed to participate (see Appendix). The Coordinating Centre (Rome, Section of Pedi- atric Neurosurgery, Catholic University, School of Medicine) re- ceived a total of 830 forms, 773 of which were considered eligible for the study. The remaining 57 could not be utilized because they contained insufficient information or reported on ineligible cases (e.g., patients with tumoral hydrocephalus). Although some forms were not completely filled out and the statistical figures relating to the different aspects of the inquiry varied, this was only to an extent so small as not to affect the overall analysis. Participating centers were in four main areas of the world: The Americas (389 patients; 50.4%) Europe (367 patients; 47.4%) Oceania (12 patients; 1.5%) Africa (5 patients; 0.7%) Male patients outnumbered female patients (430 vs 340); in 3 cases the sex was not specified. The overall mean age at operation was 3 years, with a range from 1 day to 83 years (Fig. 1). However, 38% of patients were operated on at less than 1 month of age, 35% between 1 and 6 months, 14% between 6 months and 2 years, and 10% between 2 and 18 years - accounting for 97% in all. The small percentage of adult subjects (3%) were considered a useful inclusion in this study for comparative purposes. It is worth noting that in 23% of cases the diagnosis of hydro- cephalus was obtained antenatally by ultrasonography.