Table 1.
Incidence of different complications and prevalence of the different types of morbidity according to literature
| Complications and morbidity | Data in literature | Comment on biases | |
|---|---|---|---|
| shunt obstruction |
number of shunt revisions per patient |
2.7 at 24.2 years [4] 4.2 at 20 years [26] 2.7 at 17 years [49] |
duration-dependent; rates of revision also reflects the closeness of follow-up |
| |
Event-Free Survival at 1 year |
70% [8,51] 62% [46] 80% [4] |
depends on the age at insertion and the number of prematures shunted |
| |
Event-Free Survival at 10 year |
35% [51], 48% [4] |
few data on the very long term |
| Endoscopy failure rate |
Event-Free Survival at 5 years |
62% [22] 45% [23] |
few data on the very long term |
| shunt infection |
per surgery |
0.17% [52] 7.9% [11] 8.4% [46] |
depends on definition criteria, selection of patients and duration of follow-up |
| |
per patient (long term) |
15.6% [4] 37.5% [37] |
depends on duration of follow-up |
| |
per surgeon (range within a team) |
5.2-12.2% [9] 7–9.4% [53] 6.1-11.7% [11] |
significant differences between surgeons [53]; NS[9,11] |
| |
actuarial incidence |
8.5% at 1 year [8] 20.3% at 10 years [9] |
very few data on long-term incidence |
| shunt independence |
overall |
3.2% [54] 9% [55] |
depends on etiology of hydrocephalus and eargeness to remove the shunt |
| |
successful endoscopy when shunt malfunction |
77% of attempts [15] 64% [14] |
reflects selection of patients |
| Mortality |
overall |
1.22 [56] 14.6% [57] |
depends whether tumors are included or not |
| |
non-tumoral mortality |
8.6% [58] 13.7% [49] |
depends on duration of follow-up and intercurrent events in debilitated patients |
| |
shunt-related |
0 [48] 2.9% [26] 3.65% [57] |
depends on duration of follow-up; impact of staff and patient education |
| Morbidity |
motor handicap |
30% [30] 34.2% [56] 60% [36] |
series with spina bifida |
| |
low IQ |
12.5% [47] 54.2% [48] |
selection bias for testing |
| |
normal schooling |
38% [43] 30% [36] 79% [26] |
depends on tolerance of schooling system |
| |
no schooling |
5.5% [4] 9% [30] 9% [36] |
depends on tolerance of schooling system |
| |
visual |
25% [36] 33% [59] 83% [35] |
depends on how thoroughly examined |
| |
pregnancy |
14.5% [4] 20.6% [37] |
impact of early age of shunting |
| |
epilepsy |
2%/year [60] 6.5% [4] 14% [30] 25% [57] 30% [36] 32% [39] |
associated with severe initial disease and poor outcome |
| |
depression |
43.2% [37] |
may be biased by selection (self reported morbidity) |
| |
headache |
8% [4] 44% [40] |
depends on age |
| social integration |
normal job (competitive labor market) |
33.3% [4] 56% [5] |
bias linked with protracted follow-up |
| |
sheltered job |
23% [4,26] |
depends on proactive welfare system |
| partner | 6% [5] 22% [26] 37% [37] | selection bias: studies based on voluntary participation | |