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Updated: Feb 26, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Conversion of external ventricular drainage to ventriculo-peritoneal shunt: to change or not to change the proximal
Jehuda Soleman1, Haggai Benvenisti1, Shlomi Constantini1
1Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, 6 Weizmann Street, Tel Aviv, 64239, Israel.
Insights
Converting external ventricular drainage (EVD) to ventriculo-peritoneal shunt (VPS) in pediatric patients without replacing the catheter is safe. This procedure avoids re-operation and does not significantly increase shunt infection or malfunction rates.
Area of Science:
- Pediatric Neurosurgery
- Hydrocephalus Management
- Cerebrospinal Fluid Shunting
Background:
- External ventricular drainage (EVD) is a temporary measure for cerebrospinal fluid (CSF) management.
- Conversion to a permanent ventriculo-peritoneal shunt (VPS) is often necessary.
- Replacing the ventricular catheter during conversion can increase surgical risks.
Purpose of the Study:
- To evaluate the safety and efficacy of converting a tunneled EVD to a VPS without replacing the ventricular catheter in pediatric patients.
- To determine the incidence of early shunt infection and malfunction after this conversion procedure.
- To assess if this "no-replacement" technique impacts shunt complication rates.
Main Methods:
- Retrospective review of 17 pediatric patients undergoing 18 direct EVD to VPS conversions.
- EVDs were tunneled subcutaneously prior to conversion.
- Primary outcome: occurrence of early (within 30 days) VPS infection or malfunction.
- Mean follow-up: 56.8 months.
Main Results:
- Mean EVD duration before conversion: 9.0 days.
- Overall, 5 patients experienced shunt infections/malfunctions.
- One patient (5.6%) had an early shunt infection (>30 days).
- One patient had an early shunt malfunction (9 days).
- No significant increase in early shunt infection or malfunction rates was observed.
Conclusions:
- Direct conversion of a tunneled EVD to a VPS without catheter replacement is a safe procedure in pediatric patients.
- This technique spares the cranial entry site, potentially reducing complications.
- The rates of shunt infection and malfunction are not significantly increased compared to traditional methods.
Purpose:
In this study, we investigate the occurrence rate of early shunt infection and malfunction in pediatric patients after converting an external ventricular drainage (EVD) to a ventriculo-peritoneal shunt (VPS) without replacing the ventricular catheter.
Methods:
Data was retrospectively reviewed for 17 pediatric patients (11 male (64.7%), mean age 7.5 years, range 0.25-15 years) who underwent 18 consecutive direct conversions of tunneled EVD to VPS without replacing the ventricular catheter between 2008 and 2017. In each case, the EVD was inserted in sterile fashion within the operating room and tunneled subcutaneously 5-7 cm away from the insertion site. Primary outcome measure was the occurrence of early (within 30 days) VPS infection or malfunction. The mean follow-up time was 56.8 months (±35.7 months).
Results:
The mean period of EVD before VPS placement was 9.0 days (±3.6 days, range 2-18 days). Five patients had shunt infections/malfunctions. One patient (5.6%) had an early shunt infection after 30 days. One patient had a late shunt infection after 9 months. One patient had an early shunt malfunction after 9 days. Two patients (11.1%) had late shunt malfunctions after 6.5 months and 9 years. There were no other incidents of shunt-related complications or shunt-related mortality.
Conclusion:
In the pediatric population, the conversion of a tunneled EVD to a VPS without replacing the ventricular catheter can be safely done. Cranial entry is spared, while the rates of shunt infection and malfunction do not increase significantly.
