Utility of routine postoperative imaging in adults undergoing primary ventriculoperitoneal shunts

Background: There is currently no consensus on the usefulness of postoperative imaging after ventriculoperitoneal (VP) shunt insertion in adults. The aim of this study was to investigate the utility of routine postoperative imaging (CT head scans and radiographs) following primary VP shunt insertion in a general adult population treated at a tertiary neurosurgical centre.

Methods: Patients undergoing primary VP shunt insertion between 2017-2021 were included. Actions taken based on routine postoperative imaging and need for subsequent shunt revision were recorded.

Results: 236 patients were included. The median age was 63 years (range 17-90). There was a slight female preponderance (121/236, 51.3%). The median follow-up was 38.5 months (3.1 - 60.5 months). Acute intervention was employed in 9 patients (3.9%) on the basis of routine postoperative CT head scan. Routine postoperative radiographs did not result in reoperation. Around a quarter (28.8%) of patients had a shunt revision, most of whom underwent urgent primary shunt insertions. Postoperative ventricular catheter characteristics (position of shunt tip, tip relation to septum pellucidum, and intraventricular catheter distance) were not predictive of shunt revision. Surgical urgency (emergency vs. elective procedures) was associated with long-term shunt revision (OR = 2.80, 95% CI 1.42 - 5.53, p = 0.003).

Conclusions: Routine postoperative imaging rarely led to reoperation in adult patients undergoing primary VP shunt insertion. Patients undergoing emergency shunt insertions were at the highest risk for requiring revision.