Complications
Postoperative temporary deterioration is common, and patients are at risk of stroke in the perioperative period.
A common complication, which is probably more frequent in those with significant cerebral atrophy.[39]
Shunted patients remain at a higher than average risk, particularly in the first few months after surgery, the first few months after an adjustable shunt has been changed to a lower pressure setting, or after any fall.
Patients generally present with deterioration in their overall condition, with or without fluctuating confusion.
CT scan of the brain confirms diagnosis.
If the patient has a programmable shunt, this complication may be treated by changing the shunt setting to the highest pressure, at the neurosurgeon's discretion.[40]
Bleeding along the track of the intracranial catheter may occur, but the hematoma is usually small and resolves uneventfully.
Usually caused by Staphylococcus species.
Symptoms may be nonspecific, including headache and abdominal pain.
Infection requires treatment with antibiotics, and possibly subsequent shunt removal if there is no response to antibiotic therapy.
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Approximately 75% of patients will respond positively to a shunt revision.[31]
Long-term outlook for patients is variable, but prognosis is usually determined by associated vascular disease or dementia.
Clinical improvement can be sustained for 5 to 7 years in some patients, even if shunt revision surgery is needed multiple times.[31]
With earlier diagnosis and treatment, and the increasing lifespan of the aging population, the need for long-term follow-up after shunt surgery may increase.[31]
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