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Updated: Nov 10, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Is cerebrospinal fluid sampling necessary at the time of first ventriculo-peritoneal shunt insertion in paediatric
Wen Li Chia1, Malik Zaben2, Paul Leach2
1Cardiff University, School of Medicine, Cardiff, UK.
Insights
Intraoperative cerebrospinal fluid (CSF) sampling during ventriculo-peritoneal (VP) shunt insertion is unreliable for predicting infection. This diagnostic tool is no better than chance, necessitating further research.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Infectious Disease
Background:
- Ventriculo-peritoneal (VP) shunts are crucial for hydrocephalus management.
- VP shunt infections are a significant complication, impacting patient outcomes.
- Predicting and managing shunt infections early is essential.
Purpose of the Study:
- To evaluate the utility of intraoperative cerebrospinal fluid (CSF) sampling in predicting VP shunt infections.
- To determine if intraoperative CSF analysis can guide antibiotic management post-VP shunt insertion.
Main Methods:
- Retrospective review of 83 pediatric patients undergoing 90 VP shunt insertions (2013-2019).
- Analysis of pre-operative and intra-operative CSF results, including bacterial cultures and white cell count (WCC).
- Minimum 6-month follow-up for shunt infection detection.
Main Results:
- Intraoperative CSF cultures showed 33.3% sensitivity and 98.4% specificity for predicting infection.
- Only 1 of 2 patients with positive intraoperative CSF developed infection; 2 infections occurred despite normal intraoperative CSF.
- The Area Under the Curve (AUC) for intraoperative WCC predicting infection was 50.3%, indicating performance no better than chance.
Conclusions:
- Intraoperative CSF sampling is an unreliable predictor of future VP shunt infection.
- This method is not effective in guiding antibiotic prescribing for shunt infections.
- Larger studies are required to confirm these findings and explore alternative diagnostic strategies.
Objective:
We aim to evaluate whether intraoperative cerebrospinal fluid (CSF) sampling during ventriculo-peritoneal (VP) shunt insertion can predict future VP shunt infection or guide its management.
Methods:
83 paediatric patients undergoing VP shunt insertion between February 2013 and July 2019 were retrospectively identified. Patient demographics, presence of pre-operative extra ventricular drain (EVD), pre-operative CSF results, and intra-operative CSF results were identified from patient case notes and electronic clinical databases. All included patients were followed up for a minimum of 6 months for identification of shunt infection.
Results:
90 VP shunt insertions were performed in 83 patients. Age at time of shunt insertion ranged from 5 days to 15.8 years (mean 44.2 months). Tumours were the most common aetiology for hydrocephalus (n = 24). 67 cases (74.4%) had intra-operative CSF samples, of which 2 revealed the presence of bacteria. Only 1 patient with intra-operative CSF sampling positive for growth developed shunt infection during follow up. Two cases developed a shunt infection despite normal intra-operative CSF results. Three cases did not have intra-operative CSF sampling but developed a shunt infection during follow up. Intra-operative CSF culture achieved 33.3% sensitivity and 98.4% specificity for predicting future shunt infection (p = 0.154). The Receiver Operator Characteristic (ROC) curve of intra-operative white cell count (WCC) and shunt infection at 6 months follow up yielded an Area Under the Curve (AUC) of 50.3%.
Conclusion:
Our results show that intraoperative CSF sampling as a method to predict future risk of shunt infection and to help inform future antibiotic prescribing is unreliable. Given an AUC of 50.3%, it is no better than chance as a diagnostic tool. Further larger studies are needed to substantiate this.
