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Updated: Jun 29, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Shunt timing in low-weight infants in the treatment of hydrocephalus
Peter A Chiarelli1, Nicholas Chapman1, Benjamin E Flyer2
11Division of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California; and.
Insights
This study found no significant difference in shunt survival rates for low-weight infants (<2000g) compared to standard-weight infants (2000-3000g) undergoing ventricular shunt placement for hydrocephalus.
Area of Science:
- Pediatric Neurosurgery
- Neonatal Care
- Neurosurgical Outcomes
Background:
- Optimal timing for ventricular shunt placement in low-weight and preterm infants is debated.
- Current weight thresholds for shunt placement vary significantly between institutions.
- Hydrocephalus management in neonates requires careful consideration of infant weight.
Purpose of the Study:
- To investigate shunt outcomes in low-weight infants (<2000g) compared to standard-weight infants (2000-3000g).
- To determine if infant body weight at the time of initial shunt placement impacts shunt survival.
- To provide data for informed clinical decision-making regarding neonatal hydrocephalus treatment.
Main Methods:
- Retrospective analysis of 76 infants who received primary ventriculoperitoneal (VP) shunt placement between 2003 and 2018.
- Infants were categorized into low-weight (<2000g) and standard-weight (2000-3000g) groups.
- Shunt survival rates were compared, and analyses were re-evaluated using varying weight thresholds.
Main Results:
- No significant difference in 1-year shunt survival rates between low-weight (58%) and standard-weight (58%) infants.
- Overall shunt failure rates were 46% in the low-weight group and 54% in the standard-weight group.
- No statistically significant difference in time to shunt revision was found across different weight thresholds.
Conclusions:
- Infant body weight at the time of initial shunt placement does not significantly correlate with shunt survival.
- Clinical decision-making for VP shunt placement in low-weight neonates can consider this evidence.
- Further multi-institutional studies are recommended to validate these findings.
Objective:
The optimal timing of ventricular shunt placement in low-weight and preterm infants remains an unresolved topic in modern pediatric neurosurgery. Shunt placement for hydrocephalus is performed over a wide range of infant weights, and the standard weight threshold for shunt placement can vary substantially across institutions. The aim of this study was to investigate shunt outcome in infants of low body weight.
Methods:
An IRB-approved retrospective analysis of 76 infants (29 females, 47 males) who received primary shunt placement between 2003 and 2018 was performed. Uniform criteria were used over the entire dataset to determine the safety for ventriculoperitoneal (VP) shunt placement: 1) weight near or above 1500 g, 2) feeding tolerance, and 3) lack of necrotizing enterocolitis or active systemic infection. Infants were classified into a low-weight (LW) (< 2000 g) or standard weight (SW) (2000-3000 g) group based on their body weight at the time of initial shunt placement. Shunt survival was compared between the groups. The threshold weight separating the LW and SW groups and outcomes was additionally varied and systematically reanalyzed.
Results:
Shunts were placed in 24 LW infants and 52 SW infants over the inclusion period. Etiologies for hydrocephalus were similar across groups: predominantly intraventricular hemorrhage (54%) (p = 0.13) and open neural tube defect (29%) (p = 0.61). Both LW and SW groups had 58% 1-year shunt survival rates. Overall, 46% of shunts failed in the LW group compared with 54% in the SW group over a median follow-up of 47 months (range 0-170 months). A log-rank test comparing shunt survival rates did not show significance (p = 0.43). Groups were repartitioned using a range of threshold weights (1600-2400 g) to divide LW from SW infants. The lack of association between VP shunt placement in LW infants and time frame of revision was consistently observed over the full range of varied threshold weights.
Conclusions:
There was no significant difference in overall time to shunt revision between infants weighing < 2000 g and infants weighing 2000-3000 g. No correlation between weight and shunt survival was detected. Combined with other clinical features pertinent to the management of hydrocephalus in the neonatal population, this investigation provides insight toward clinical decision-making regarding infants of low birth weight and suggests that further multi-institutional study on this topic is warranted.
