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Updated: Oct 20, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Pediatric shunt revision analysis within the first year of shunt placement: A single center experience
Muhammad Azzam1, Roidah Taqiyya Zahra Wathoni1, Wihasto Suryaningtyas2
1Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia.
Insights
Hydrocephalus shunt revision remains high, with 18.3% of pediatric patients requiring reoperation within a year. Infants under six months face a significantly higher risk of shunt failure and revision surgery.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Cerebrospinal Fluid (CSF) Dynamics
Background:
- Hydrocephalus management often involves shunt placement, a procedure prone to complications.
- Despite advancements, shunt failure rates remain substantial, impacting patient outcomes.
- Shunt revision is a common neurosurgical procedure, indicating ongoing challenges in initial placement success.
Purpose of the Study:
- To evaluate the incidence and risk factors for shunt revision in pediatric neurosurgery patients.
- To analyze the causes and timing of shunt revision within the first year post-placement.
- To identify patient demographics and conditions associated with increased shunt revision rates.
Main Methods:
- An observational retrospective study of pediatric patients undergoing CSF shunting procedures (VPS, VAS, CPS, subdural-peritoneal).
- Data collected from January 2018 to May 2019, with a 12-month follow-up for complications.
- Statistical analysis to determine risk factors, including patient age and diagnosis.
Main Results:
- 18.3% of 142 patients required shunt revision within 12 months; Ventriculoperitoneal Shunts (VPS) were most common (96.2%).
- Infants under 6 months had a 2.32 times higher risk of revision (P=0.018).
- Congenital anomalies were the leading diagnosis (61.5%), with shunt malfunction (80.8%) as the primary cause for revision.
Conclusions:
- The first-year shunt revision rate is notably high, emphasizing the need for long-term patient monitoring.
- Regular, long-term follow-up is crucial for assessing shunt outcomes and patient well-being.
- Shunt registries can facilitate efficient and sustainable follow-up, improving management strategies.
Background:
Hydrocephalus is a common problem in neurosurgery with shunt placement remains the mainstay of the management. However, shunt placement generally requires following surgical procedures, including shunt revision. Despite the recent developments, the incidence of shunt failure remains high, approximately 30-51% in the 1st year following the shunt placement.
Methods:
An observational retrospective study of pediatric neurosurgery patients whom underwent CSF shunting procedure, both primary and repeated VPS, VAS, CPS, and subdural-peritoneal shunt procedures between January 2018 and May 2019. The patients were observed for 12 months for potential complication requiring shunt revision following the shunt placement.
Results:
A total of 142 patients underwent shunt placement. The shunt revision within 12 months was found in 26 patients (18.3%), 25 cases were VPS (96.2%) and one case was CPS (3.8%). The mean period of time between shunt placement to shunt revision was 3.96 months. Age of under 6 months old during the shunt placement showed significantly higher risk for shunt revision (RR 2.32 CI 1.13-4.74, P = 0.018). The most common diagnosis requiring shunt revision was congenital anomaly (16 cases, 61.5%). The most common cause of revision was shunt malfunction, with 21 cases (80.8%) followed by infected shunt with 5 cases (19.2%).
Conclusion:
The 1st year observation showed relatively high rate for shunt revision. The patient underwent shunt procedure should be regularly followed up in long period for better evaluation of the outcome. The application of shunt registry in some countries appears to be efficient and beneficial for sustainable follow-up in patients underwent shunt placement.
