Original Paper Pediatr Neurosurg 2003;38:34–40 DOI: 10.1159/000067561 Comparison of Total versus Partial Revision of Initial Ventriculoperitoneal Shunt Failures Matthew J. McGirt John C. Wellons III Shahid M. Nimjee Ketan R. Bulsara Herbert E. Fuchs Timothy M. George Pediatric Neurosurgery Service, Division of Neurosurgery, Duke University Medical Center, Durham, N.C., USA Received: June 6, 2002 Accepted: August 6, 2002 Timothy M. George, MD Pediatric Neurosurgery Service Box 3272, Duke University Medical Center Durham, NC 27710 (USA) Tel. +1 919 684 5013, Fax +1 919 681 8272, E-Mail georg017@mc.duke.edu ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2003 S. Karger AG, Basel 1016–2291/03/0381–0034$19.50/0 Accessible online at: www.karger.com/pne Key Words Ventriculoperitoneal shunt failure W Revision W Hydrocephalus Abstract Background: Optimal surgical management of patients presenting with shunt failure in the age of neuroendos- copy remains complex. The value of replacing the entire shunt system as opposed to a single shunt component has not been assessed. M ethods: We reviewed the rec- ords of all pediatric patients who underwent their first shunt revision between January 1992 and December 1998. Patients with primary shunt failure attributed sole- ly to proximal catheter obstruction or distal catheter obstruction were included for analysis. Shunt revisions were classified as total (entire shunt replaced) or partial (only malfunctioning component replaced). Kaplan- Meier (shunt survival curves) and log rank analysis were used to compare failure rates between partially and total- ly revised shunts according to the underlying diagnosis and failed shunt part. Significant differences in univari- ate analysis were confirmed with a multivariate propor- tional hazards regression model. Results: 301 pediatric patients underwent primary shunt revision (183 total, 118 partial revisions). All shunts utilized distal slit perito- neal catheters. In shunt failures attributed to proximal obstruction, reutilization of the distal catheter was asso- ciated with a 57% increased risk of subsequent shunt fail- ure (hazard ratio 1.57, 95% confidence interval 1.19– 3.49). In shunt failures attributed to distal obstruction, subsequent shunt survival was not affected by reutiliza- tion of the proximal catheter (p = 0.581). When stratified according to the etiology of hydrocephalus, only patients with intraventricular hemorrhage (IVH) failed to demon- strate greater survival of totally revised shunts. Conclu- sions: In this series, in the setting of proximal shunt cath- eter obstruction, reutilizing the functional distal catheter was associated with an increase in subsequent shunt failure rates compared to revising the entire shunt sys- tem. Total revision was not associated with improved shunt survival in patients with IVH. Copyright © 2003 S. Karger AG, Basel