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Updated: Aug 8, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Preliminary study of shunt related death in paediatric patients
M J Bryant1, J McEniery, D G Walker
1Neurosurgery Department, Royal Brisband Hospital, Herston, 4069 Qld., Australia.
Insights
Cerebrospinal fluid (CSF) shunting for hydrocephalus can lead to mortality from mechanical failure, even years after surgery. This review highlights the risks and suggests considering alternative treatments or emergency access methods.
Area of Science:
- Neurosurgery
- Paediatric Neurosurgery
- Neurology
Background:
- Hydrocephalus management often involves cerebrospinal fluid (CSF) shunting.
- Despite technological advancements, CSF shunts have associated morbidity and mortality.
- Early shunt obstruction is a significant concern, with later failures also occurring.
Purpose of the Study:
- To review mortality associated with mechanical failure of CSF shunts in Queensland.
- To identify trends and contributing factors in shunt failure-related deaths.
Main Methods:
- Review of neurosurgical and intensive care databases.
- Inclusion of mortality cases linked to CSF shunt failure between 1992 and 2002.
- Analysis of patient demographics and timing of death relative to shunt revisions.
Main Results:
- Eight cases of mortality due to shunt failure were identified between 1992 and 2002.
- The average age at death was 7.7 years, with deaths occurring approximately 2 years post-shunt revision.
- A majority of fatal cases (7 out of 8) involved patients from outside metropolitan areas.
Conclusions:
- CSF shunting for hydrocephalus remains an imperfect treatment with potential for mortality at any time post-surgery.
- Delays in surgical intervention appear to influence mortality outcomes.
- Alternative treatments like third ventriculostomy or access devices, and emergency ventricular access strategies, warrant consideration.
Abstract:
Hydrocephalus is a condition commonly encountered in paediatric and adult neurosurgery and cerebrospinal fluid (CSF) shunting remains the treatment of choice for many cases. Despite improvements in shunt technology and technique, morbidity and mortality remain. The incidence of early shunt obstruction is high with later failures seen less frequently. This review aims to examine mortality associated with mechanical failure of CSF shunts within Queensland. Neurosurgical and Intensive Care databases were reviewed for cases of mortality associated with shunt failure. Eight cases were identified between the years of 1992 and 2002 with the average age at death 7.7 years. Deaths occurred on average 2 years after last shunt revision. Seven of the eight patients lived outside the metropolitan area. Shunting remains an imperfect means of treating hydrocephalus. Mortality may be encountered at any time post surgery and delays to surgical intervention influence this. Alternative measures such as third ventriculostomy or the placement of a separate access device should be considered. In the event of emergency, a spinal needle could be used to access the ventricle along the course of the ventricular catheter.
