A prospective, randomized study of shunt function and infections as a function of shunt placement

Much controversy still exists about the relative advantages and disadvantages of anteriorly vs. posteriorly placed shunts in terms of infection rate and duration of function. During a 27-month period, all 121 patients seen requiring new shunt insertions were prospectively randomized to anterior or posterior placement. The mean duration of follow-up was 15 months. 70% of the shunts in the posteriorly placed group vs. 59% of the shunts in the anteriorly placed group did not require further surgery during the study period. In a life-table analysis of shunt survival as a function of placement, the shunts in the posteriorly placed group 'survived' slightly longer without malfunctioning or becoming infected than the anteriorly placed shunts. Therefore, the authors conclude that anteriorly placed shunts offer no advantage over posteriorly placed shunts in terms of shunt malfunction or infection.