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Updated: Jun 28, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Ventricular catheter tissue obstruction and shunt malfunction in 9 hydrocephalus etiologies
Maria Garcia-Bonilla1,2, Prashant Hariharan3, Jacob Gluski4
11Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Insights
Tissue obstruction in ventricular catheters (VCs) is common in hydrocephalus shunt malfunctions. However, this study found no clear link between the degree of tissue obstruction and the specific cause of hydrocephalus.
Area of Science:
- Neurology
- Biomedical Engineering
- Pediatric Neurosurgery
Background:
- Hydrocephalus affects 80-125 per 100,000 US births.
- Ventricular shunting, the primary treatment, has high failure rates (up to 85% within 10 years).
- Ventricular catheter (VC) obstruction is a significant factor in shunt malfunction.
Purpose of the Study:
- To investigate the association between tissue obstructions in VCs and shunt malfunction.
- To analyze this association across different hydrocephalus etiologies.
Main Methods:
- Collected patient data from 5 hospitals, categorized by hydrocephalus etiology.
- Macroscopically analyzed fixed VC tips to classify tissue obstruction in drainage holes.
- Correlated shunt malfunction data (revision rates, time to failure) with VC tissue obstruction levels.
Main Results:
- Posthemorrhagic hydrocephalus was the most common etiology (48.9%).
- Proximal catheter obstruction was the primary reason for hardware removal (90.4%).
- 76.8% of removed VCs showed cellular or tissue aggregates; however, no etiological associations were found with obstruction levels, age at surgery, or shunt failure rates.
Conclusions:
- Proximal VC obstruction frequently involves tissue aggregates (76.8% of cases).
- The presence of tissue within the VC did not demonstrate a clear association with specific hydrocephalus etiologies.
Objective:
Hydrocephalus is a neurological disorder with an incidence of 80-125 per 100,000 births in the United States. The most common treatment, ventricular shunting, has a failure rate of up to 85% within 10 years of placement. The authors aimed to analyze the association between ventricular catheter (VC) tissue obstructions and shunt malfunction for each hydrocephalus etiology.
Methods:
Patient information was collected from 5 hospitals and entered into a REDCap (Research Electronic Data Capture) database by hydrocephalus etiology. The hardware samples were fixed, and each VC tip drainage hole was classified by tissue obstruction after macroscopic analysis. Shunt malfunction data, including shunt revision rate, time to failure, and age at surgery, were correlated with the degree of tissue obstruction in VCs for each etiology.
Results:
Posthemorrhagic hydrocephalus was the most common etiology (48.9% of total cases). Proximal catheter obstruction was the most frequent cause of hardware removal (90.4%). Myelomeningocele (44% ± 29%), other congenital etiologies (48% ± 40%), hydrocephalus with brain tumors (45% ± 35%), and posthemorrhagic hydrocephalus (41% ± 35%) showed tissue aggregates in more than 40% of the VC holes. A total of 76.8% of samples removed because of symptoms of obstruction showed cellular or tissue aggregates. No conclusive etiological associations were detected when correlating the percentage of holes with tissue for each VC and age at surgery, shunt revision rates, or time between shunt implantation and removal.
Conclusions:
The proximal VC obstruction was accompanied by tissue aggregates in 76.8% of cases. However, the presence of tissue in the VC did not seem to be associated with hydrocephalus etiology.
