Risk factors for new-onset shunt-dependency after craniotomies for intracranial tumors in adult patients

The risk of developing a de novo shunt-dependent hydrocephalus (HC) after undergoing a craniotomy for brain tumor in adult patients is largely unknown. All craniotomies for intracranial tumors at Oslo University Hospital in adult patients ae<yen>18 years of age during a 10-year period (2004-2013) were included. None were lost to follow-up. Patients who developed a shunt-dependent HC were identified by cross-linking our prospectively collected tumor database to patients with a NCSP surgical procedure code of hydrocephalus (AAF). Patients with pre-existing HC or ventriculoperitoneal (VP) shunts were excluded from the study. A total of 4401 craniotomies were performed. Of these, 46 patients (1.0%) developed de novo postoperative HC requiring a VP shunt after a median of 93 days (mean 115 days, range 6-442). Median age was 62.0 years (mean 58.9 years, range 27.3-80.9) at time of VP shunt surgery. Patients without pre-existing HC had a 0.2% (n = 8/4401) risk of becoming VP shunt dependent within 30 days and 0.5% (n = 22/4401) within 90 days. Age, sex, tumor location, primary/secondary surgery, and radiotherapy were not associated with VP shunt dependency. Choroid plexus tumors and craniopharyngiomas had increased risk of VP shunt dependency. In this large, contemporary, single-institution consecutive series, the risk of postoperative shunt-dependency after craniotomies for brain tumors without pre-existing HC was very low. This is the largest study with regards to de novo postoperative shunt-dependency after craniotomies for patients with intracranial tumors and can serve as a benchmark for future studies.