Establishing a Preoperative Evaluation System for Lumboperitoneal Shunt: Approach to Attenuate the Risk of Shunt Failure

Objective: Lumboperitoneal shunt (LPS) has been demonstrated an effective method for the treatment of communicating hydrocephalus in the presence of frequent shunt failure. The objective of the present study was to determine whether establishing a preoperative evaluation system could benefit patients, thus attenuating the risk of LPS failure.

Methods: In this 3-year study, treated by LPS, patients undergoing preoperative evaluation were included into the study group and other individuals without preoperative evaluation were included into the control group. Perioperative conditions, including Keifer's hydrocephalus score, symptomatic control rate, Evans index, complications, long-term shunt revision rate, and quality of life, were synchronously investigated.

Results: A total of 93 eligible patients were included in the study (study group, 51; control group, 42). The baseline characteristics of the 2 groups were basically similar. The results showed that patients in the study group had better short-term improvement in symptoms and imageology, including higher symptomatic control rate (median, 62.5% vs. 50%; P = 0.001), more reduction in Evans index (0.08 ± 0.05 vs. 0.05 ± 0.04; P = 0.002), and lower incidence of postoperative complications (median, 35.3% vs. 57.1%; P = 0.04). Similarly, the incidence of shunt revision in the study group was dramatically lower than in the control group (median, 15.7% vs. 40.9%; P = 0.006) in line with the revision-free curve (P = 0.002), which suggested that most of patients received revision, if needed, within 3 months. In addition, patients in the study group had better quality of life.

Conclusions: In conclusion, patients who underwent evaluation before LPS had better short-term and long-term outcomes, suggesting that it would be a promising strategy to correctly select patients for LPS with prolonged favorable shunt outcomes.