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Updated: Nov 4, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Craniosynostosis Develops in Half of Infants Treated for Hydrocephalus with a Ventriculoperitoneal Shunt
Justin R Bryant1, Esperanza Mantilla-Rivas1, Robert F Keating1
1From the Divisions of Plastic and Reconstructive Surgery and Neurosurgery, the Joseph E. Roberts, Jr., Center for Surgical Care, and the Department of Radiology, Children's National Hospital.
Insights
Nearly half of infants with hydrocephalus developed craniosynostosis after ventriculoperitoneal shunt placement. The sagittal suture was most commonly affected, with older age and more revisions predicting risk.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Neurology
Background:
- Craniosynostosis is a rare complication following ventriculoperitoneal shunt placement for hydrocephalus.
- Understanding the risk is crucial for patient management and surgical planning.
Purpose of the Study:
- To determine the general risk of developing craniosynostosis in infants who receive a ventriculoperitoneal shunt for hydrocephalus.
Main Methods:
- Retrospective review of 125 infants who underwent ventriculoperitoneal shunt placement for hydrocephalus (2006-2012).
- Evaluation of pre- and post-shunt computed tomographic images for craniosynostosis by a clinical panel.
- Exclusion of patients with pre-existing craniosynostosis, syndromes, or poor image quality.
Main Results:
- 48.8% of patients (61/125) developed craniosynostosis at a median of 26 months post-shunt placement.
- The sagittal suture was most commonly fused (n=25 single suture, n=30 multiple sutures).
- Older age at shunt placement and increased shunt revisions were independent predictors of craniosynostosis.
Conclusions:
- Craniosynostosis affects nearly half of infants treated with ventriculoperitoneal shunts for hydrocephalus.
- Sagittal suture fusion is the most frequent outcome.
- The long-term impact on cranial growth and shunt function remains unclear.
Background:
Craniosynostosis following placement of a ventriculoperitoneal shunt for hydrocephalus has been sporadically described. The purpose of this investigation was to determine the general risk of developing craniosynostosis in this patient population.
Methods:
The authors retrospectively reviewed records and radiographs of infants who underwent ventriculoperitoneal shunt placement for hydrocephalus from 2006 to 2012. Recorded variables included date of shunt placement, demographics, comorbidities, cause of hydrocephalus, shunt type, and number of shunt revisions. Axial computed tomographic images obtained before and immediately after shunt placement and 2 to 4 years after shunt placement were evaluated by a panel of clinicians for evidence of craniosynostosis. Patients with preshunt craniosynostosis, craniosynostosis syndromes, or poor-quality computed tomographic images were excluded. Data were analyzed using STATA Version 15.1 statistical software.
Results:
One hundred twenty-five patients (69 male and 56 female patients) were included. Average age at shunt placement was 2.3 ± 2.58 months. Sixty-one patients (48.8 percent) developed craniosynostosis at a median of 26 months after shunt placement. Of these, 28 patients fused one suture; the majority involved the sagittal suture (n = 25). Thirty-three patients fused multiple sutures; the most common were the coronal (n = 32) and the sagittal (n = 30) sutures. Multivariable logistic regression identified older age at shunt placement and more shunt revisions as independent predictors of craniosynostosis. Shunt valve type was not significant.
Conclusions:
Craniosynostosis developed in nearly half of infants who underwent ventriculoperitoneal shunt placement for hydrocephalus. The sagittal suture was most commonly involved. The effect of suture fusion on subsequent cranial growth, shunt failure, or the development of intracranial pressure is unclear.
Clinical Quesiton/Level Of Evidence:
Risk, III.
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