Introduction: Ventriculoperitoneal shunting remains the most widely used neurosurgical procedure for the management of hydrocephalus but there remains no consensus on whether post-operative imaging should be obtained. The objective of this study was to evaluate whether obtaining post operative CT scan would affect rates of revision.
Methods: A total of 49 adult and pediatric patients undergoing ventriculoperitoneal shunt placement in 2007 were included in the study. Medical charts, operative reports, imaging studies, and clinical follow up evaluations were reviewed and analyzed retrospectively.
Results: A total of six revisions were done in the first thirty days. 16% of the revisions were within the first two post operative days due to post operative imaging findings. Out of the total revisions required in the period from post operative day 3 to post operative day 30 from the initial shunt placement 40% had post operative head CT and 60% did not. The odds ratio for revision within thirty days without a CT scan when compared to those with CT scan is 1.43 (95% confidence interval, 0.22-9.42).
Conclusions: Evaluation of this data suggests that although there may be some benefit of CT scans immediately post operatively to evaluate for malpositioning so revision may be completed immediately if there is concern. However to fully evaluate this question a larger number of patients must be reviewed.
Patient Care: In an increasingly cost consious world if no statistical difference is seen in the rates of revision in the group of patients recieving post operative CT scans versus those without imaging then one may be able to change his or her practice to rely solely on clinical symptoms of shunt malfunction for revision.
Learning Objectives: By conclusion of this session participants should ne able to understand the effect of post operative CT scan ands its effect on rates of immediate revision versus delayed revision