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Updated: Jul 3, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Antimicrobial suture wound closure for cerebrospinal fluid shunt surgery: a prospective, double-blinded, randomized
Curtis J Rozzelle1, Jody Leonardo, Veetai Li
1Women and Children's Hospital of Buffalo, Kaleida Health, Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York 14222, USA. crozzelle@kaleidahealth.org
Insights
Antimicrobial sutures (AMS) significantly reduced cerebrospinal fluid (CSF) shunt infection rates compared to conventional sutures in a randomized trial. This finding suggests AMS may improve patient outcomes in pediatric neurosurgery.
Area of Science:
- Neurosurgery
- Infectious Disease Prevention
- Surgical Innovation
Background:
- Cerebrospinal fluid (CSF) shunting is vital for treating hydrocephalus but carries a 5-15% infection risk.
- Shunt infections necessitate device removal, prolonged antibiotics, and increase morbidity.
- Current infection prevention strategies are crucial in pediatric neurosurgery.
Purpose of the Study:
- To prospectively evaluate the incidence of CSF shunt infection.
- To compare outcomes between antimicrobial suture (AMS) and conventional suture use.
- To assess the safety and efficacy of AMS in reducing shunt infections.
Main Methods:
- A single-center, prospective, double-blinded, randomized controlled trial.
- 61 patients underwent 84 CSF shunt procedures over 21 months.
- Patients were randomized to AMS or placebo, with infection incidence as the primary outcome within 6 months.
Main Results:
- The shunt infection rate was 4.3% with AMS versus 21% with conventional sutures (p=0.038).
- No significant differences in known shunt infection risk factors were observed between groups.
- No adverse events related to AMS were reported.
Conclusions:
- Antimicrobial sutures (AMS) appear safe and effective for CSF shunt surgery wound closure.
- AMS may be associated with a reduced risk of postoperative shunt infection.
- A larger trial is warranted to confirm these findings.
Object:
Implantation of cerebrospinal fluid (CSF) shunting devices is associated with a 5-15% risk of infection as cited in contemporary pediatric neurosurgical literature. Shunt infections typically require complete removal of the device and prolonged antibiotic treatment followed by shunt replacement. Moreover, shunt infections are commonly associated with prolonged hospital stays, potential comorbidity, and the increased risk of neurological compromise due to ventriculitis or surgical complications. The authors prospectively evaluated the incidence of CSF shunt infection following shunt procedures performed using either antimicrobial suture (AMS) or conventional suture.
Methods:
In a single-center, prospective, double-blinded, randomized controlled trial, the authors enrolled 61 patients, among whom 84 CSF shunt procedures were performed over 21 months. Randomization to the study (AMS) or control (placebo) group was stratified to minimize the effect of known shunt infection risk factors on the findings. Antibacterial shunt components were not used. The primary outcome measure was the incidence of shunt infection within 6 months of surgery.
Results:
The shunt infection rate in the study group was 2 (4.3%) of 46 procedures and 8 (21%) of 38 procedures in the control group (p = 0.038). There were no statistically significant differences in shunt infection risk factors between the groups (procedure type and time, age < 6 months, weight < 4 kg, recent history of shunt infection). No suture-related adverse events were reported in either group.
Conclusions:
These results support the suggestion that the use of AMS for CSF shunt surgery wound closure is safe, effective, and may be associated with a reduced risk of postoperative shunt infection. A larger randomized controlled trial is needed to confirm this association.