• Bedjan Behmanesh, Fee Keil, Daniel Dubinski, Sae-Yeon Won, Johanna Quick-Weller, Volker Seifert, and Florian Gessler.
• Department of Neurosurgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany. Electronic address: bedjan.behmanesh@gmail.com.
• World Neurosurg. 2019 Jan 1; 121: e159-e164.

BackgroundPatients with a ventriculoperitoneal shunt for hydrocephalus often undergo multiple follow-up computed tomography (CT) scans of the head, increasing the risk for long-term effects of ionizing radiation. The purpose of our study was to evaluate the necessity as a routine diagnostic procedure and cost analysis of routine postoperative CT scan of the head after ventriculoperitoneal shunt surgery.MethodsIn this study, we comprised adults with ventriculoperitoneal shunt operations who underwent early CT scans within 48 hours postoperatively. We reviewed the correlation between revision surgery rate and the experience of surgeons who performed surgery and provided a cost analysis.ResultsIn total, 479 surgeries were performed in 439 patients. Early revision surgery was performed in 11 (2.3%) patients. Reason for revision surgery was malposition in 9 cases and intracerebral hemorrhage in 2 patients. There was no significant correlation between the surgeon's experience and the rate of revision surgery. Placement of the ventricular catheter via an approach other than a standard right or left frontal burr hole resulted in risk of need for surgical shunt revision (P ≥ 0.002, odds ratio 54, confidence interval 13.5-223). A total of 468 CT scans of the head revealed a normal finding; thus, ∼$562,000 could be saved by omitting postoperative head CT scans.ConclusionsRoutine postoperative head CT scans after fentriculoperitoneal shunting are not necessary in all cases. The reduction of exposure to ionization radiation and the beneficial economic factor are main advantages.Copyright © 2018 Elsevier Inc. All rights reserved.

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