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Updated: Jan 6, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
A Comparison of Ventriculoperitoneal and Ventriculoatrial Shunts in a Population of 544 Consecutive Pediatric
George N Rymarczuk1,2, Robert F Keating1, Daniel J Coughlin2
1Division of Neurosurgery, Children's National Health System, Washington, District of Columbia.
Insights
Ventriculoatrial shunts (VAS) show similar long-term survival to ventriculoperitoneal shunts (VPS) when elective lengthenings are excluded. VAS have lower infection rates, making them a viable alternative for pediatric hydrocephalus, especially in older children.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Biomedical Engineering
Background:
- Ventriculoperitoneal shunts (VPS) are standard for pediatric hydrocephalus.
- Long-term outcomes of ventriculoatrial shunts (VAS) are not well-established.
Purpose of the Study:
- Compare long-term outcomes and adverse events of VPS and VAS.
- Evaluate the efficacy of different shunt types in pediatric hydrocephalus.
Main Methods:
- Retrospective analysis of 544 pediatric patients undergoing CSF shunting.
- Follow-up duration of at least 90 days (VPS: 5.9 years; VAS: 5.3 years).
Main Results:
- 54% of VPS and 60% of VAS required revision.
- VAS showed lower infection and proximal failure rates.
- VPS had superior survival in children under 7, but no difference in older children.
Conclusions:
- VAS is a useful alternative to VPS when abdominal access is limited.
- Excluding elective lengthenings, VAS and VPS show comparable survival rates.
- VAS is particularly beneficial for older children with hydrocephalus.
Background:
Although ventriculoperitoneal shunts (VPS) remain the first-line option in most instances of pediatric hydrocephalus, the long-term efficacy of ventriculoatrial shunts (VAS) remains unknown.
Objective:
To characterize the long-term outcomes and adverse occurrences associated with both VPS and VAS at our institution.
Methods:
The authors retrospectively analyzed all cerebrospinal fluid (CSF) shunting procedures performed over a 13-yr period at a single institution. A total of 544 pediatric shunt patients were followed for at least 90 d (VPS: 5.9 yr; VAS: 5.3 yr).
Results:
A total of 54% of VPS and 60% of VAS required at least 1 revision. VPS demonstrated superior survival overall; however, if electively scheduled VAS lengthening procedures are not considered true "failures," no statistical difference is noted in overall survival (P = .08). VPS demonstrated significantly greater survival in patients less than 7 yr of age (P = .001), but showed no difference in older children (P = .4). VAS had a significantly lower rate of infection (P < .05) and proximal failure (P < .001).
Conclusion:
VAS can be a useful alternative to VPS when the abdomen is unsuitable, particularly in older children. Although VPS demonstrates superior overall survival, it should be understood that elective VAS lengthening procedures are often necessary, especially in younger patients. If elective lengthening procedures are not considered true failures, then the devices show similar survival.
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