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Updated: Jul 7, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Antibiotic-impregnated shunt catheters for the treatment of infantile hydrocephalus
Daniel M Sciubba1, Joseph C Noggle, Benjamin S Carson
1Department of Pediatric Neurological Surgery, Johns Hopkins University, Baltimore, MD 21287, USA.
Insights
Antibiotic-impregnated shunt (AIS) components are safe for infants with hydrocephalus, including premature infants. Further research may explore antibiotic impregnation in ventricular access devices (VADs) for premature neonates.
Area of Science:
- Pediatric Neurosurgery
- Infectious Disease Prevention
- Medical Device Technology
Background:
- Antibiotic-impregnated shunt (AIS) components reduce shunt infections by preventing bacterial colonization during implantation.
- Concerns persist regarding the use of AIS components in infants, particularly premature neonates, despite demonstrated efficacy in infection prevention.
Purpose of the Study:
- To assess the clinical outcomes of infants under one year of age with hydrocephalus following the placement of AIS components.
- To evaluate the safety and efficacy of AIS in a pediatric population, with a focus on premature infants.
Main Methods:
- A prospective observational study involved pediatric patients under one year of age with hydrocephalus.
- Patients underwent placement of AIS components (ventriculoperitoneal, ventriculoatrial, cystoperitoneal) as initial treatment, for shunt revision, or after ventricular access device (VAD) placement.
- Outcomes measured included infection rates, need for shunt revision surgery, and overall complications.
Main Results:
- 108 AIS procedures were performed on 74 infants, followed for over 9 months.
- The infection rate was 4.6% of procedures (6.75% of patients), with 60% of infections occurring in very premature infants (<32 weeks).
- 44.6% of patients required shunt revision surgery (15% for infection, 85% for malfunction); no mortalities occurred.
Conclusions:
- AIS systems are safe for treating hydrocephalus in pediatric patients under one year old, including those with a history of prematurity.
- Antibiotic impregnation in VADs or ventriculosubgaleal components could be a therapeutic strategy for premature infants with hydrocephalus awaiting definitive shunt placement.
Introduction:
Antibiotic-impregnated shunt (AIS) components decrease shunt infections by preventing bacterial colonization that occurs during implantation. Despite studies showing improved efficacy in preventing infection however, concern still exists regarding using AIS components in infants, especially premature ones. In this study, clinical outcomes were assessed in infants with hydrocephalus (<1 year) following AIS placement.
Methods:
A prospective observational study was conducted involving pediatric patients <1 year of gestational age with hydrocephalus who underwent placement of AIS components (ventriculoperitoneal, ventriculoatrial, and cystoperitoneal) as initial treatments, shunt revision surgery, or following previous placement of a ventricular access device (VAD, Rickman reservoir). Measured outcomes included: infection, shunt revision surgery, and complications.
Results:
Seventy-four infants underwent 108 AIS procedures, and all were followed for over 9 months. Twenty-seven patients (36.5%) possessed previous VADs. Average weight and gestational age at birth were 1,976 g (range: 560-3,500 g) and 32.8 weeks (range: 23-41 weeks), respectively. The average age at the time of surgery was 14.6 weeks (range: 1 day to 50 weeks). Five infections occurred in 5 patients (4.6% of procedures, 6.75% of patients), 60% of which were very premature (<32 weeks). Thirty-three patients (44.6%) required shunt revision surgery, 5 (15%) for infection and 28 (85%) for malfunction. Three cerebrospinal fluid leaks occurred perioperatively without significant sequelae, and no mortalities occurred from the procedures.
Conclusion:
AIS systems can safely be used to treat hydrocephalus in pediatric patients <1 year old, even for those with a history of prematurity. One possible therapeutic application for such premature patients may be the incorporation of antibiotic impregnation into VADs or ventriculosubgaleal components to treat infants with hydrocephalus prior to definitive CSF shunt placement.
