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Updated: Aug 8, 2026

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Hydrocephalus shunt infections
1Department of Microbial Diseases, City Hospital, Nottingham, UK.
Insights
Hydrocephalus shunt infections, common in infants, are difficult to diagnose. Treatment typically requires shunt removal, but new therapies show promise.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Hydrocephalus is commonly diagnosed in infancy, requiring cerebrospinal fluid shunts.
- Shunts are susceptible to colonization by Staphylococcus epidermidis, particularly in infants.
- Infant shunt infections are more frequent due to prolonged hospital stays and bacterial factors.
Purpose of the Study:
- To review the diagnosis and treatment of cerebrospinal fluid shunt colonization and infections.
- To highlight diagnostic challenges, especially in infants and the elderly.
- To discuss current and emerging treatment strategies for shunt infections.
Main Methods:
- Literature review of hydrocephalus shunt infections.
- Analysis of diagnostic difficulties and serological test utility.
- Evaluation of treatment outcomes for various therapeutic regimens.
Main Results:
- Shunt colonization by Staphylococcus epidermidis is a significant complication.
- Diagnosis of shunt colonization is challenging, with serological tests being crucial.
- Effective treatment often involves shunt removal, though alternative strategies are under investigation.
- Intraventricular vancomycin with intravenous rifampicin shows high success rates.
Conclusions:
- Hydrocephalus shunt infections require prompt and effective management.
- Accurate diagnosis, particularly in vulnerable populations, is critical.
- Optimized treatment regimens, including novel intraventricular therapies, are essential for successful outcomes.
Abstract:
Hydrocephalus is most commonly diagnosed in the first few months of life, though cases also arise in later life. Cerebrospinal fluid shunts used to control the condition are prone to colonization particularly by Staphylococcus epidermidis. The incidence is very much higher in infancy than in older age groups, and this is probably due to prolonged hospital stay as a result of the underlying pathology, combined with the propensity for a high skin bacterial density with more adherent strains, rather than to any immune immaturity. Diagnosis of shunt colonization is often very difficult and serological tests have an important role to play even in infancy. There are several pitfalls in diagnosis, particularly in the elderly. Treatment of shunt infections should include removal of the colonized shunt, though regimens to avoid this are currently being investigated. Intraventricular therapy with vancomycin along with intravenous rifampicin offers the best changes of success at the first attempt. Shunted patients who contract purulent bacterial meningitis should not have their shunts removed but should be treated in the same way as those without shunts.
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