Long-term outcomes of patients requiring cerebrospinal fluid shunts
Modern hydrocephalus treatment nears its sixth decade after Frank Nulsen, Eugene Spitz, John Holter and others pioneered the first successful cerebrospinal fluid shunts. Yet, since the development of these life-saving devices, the long-term impact of mechanical CSF diversion has not been thoroughly studied. A retrospective, single-center study analyzed 40-year outcomes among a cohort of 128 pediatric patients who had their first shunt placed for any reason between 1967-1970. Through extensive chart review, the authors report detailed patient outcomes including shunt-related morbidity and mortality, revision rate and shunt dependency. Through surveys (36-Item Short Form Health Survey and Barthel Index score), the investigators also quantitated functional status and self-perceived health among survivors. Remarkably, no patients were lost to follow-up. In the pre-shunt era, the mortality rate in the hydrocephalic population was as high as 80%, with a significant rate of developmental disabilities in the survivors. There continues to be a high mortality rate of 48% in this patient population, with a 12% mortality rate in the first 2 years after shunt placement in non-tumor patients. As might be predicted, shunt revisions were exceedingly common: Only 5 surviving patients have not required a shunt revision. Furthermore, the majority of long-term survivors (88%) remained dependent on their shunt. Measures of functional and social outcome demonstrate significant challenges for this patient population, and are strongly dependent on underlying etiology. Although these results must be viewed through a changing clinical environment over the >40-year follow-up period, the study highlights the ongoing long-term challenges and complexity of shunt-dependent hydrocephalus management.