Since the ventricular catheter must, of necessity, traverse the cerebral cortex, there has been concern as to whether this increases the risk of epilepsy for hydrocephalic patients. Whilst a number of studies have attempted to address this question, drawing meaningful conclusions is compromised by the heterogeneity of cases included and variable definitions of epilepsy. Dan and Wade [25] reported that 9.4% of 180 cases of hydrocephalus of variable etiology developed epilepsy after shunting. These authors cite multiple revisions and use of the frontal route of insertion as particular risk factors. Their methodology and conclusions have, however, attracted criticism. Many authors report the incidence of epilepsy in shunted patients to be much greater than this. In an actuarial analysis of 464 patients, Piatt and Carlson [26] found an incidence of epilepsy (defined by the use of anticonvulsant medication) of 12% at the time of diagnosis rising to 33% at 10 years post-shunting. They emphasize that the underlying cause of the hydrocephalus, in particular post-hemorrhage and post-infection, was a far more important predictor of the risk of epilepsy than any surgical factors, including shunt position, number of revisions or history of shunt infection, none of which reached statistical significance. Reporting cases of congenital hydrocephalus only, Noetzel and Blake also favor patient factors, specifically mental retardation and cerebral malformations, as best indicators of long-term epilepsy in shunted patients [27].

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