Conversion of external ventricular drainage to ventriculo-peritoneal shunt: to change or not to change the proximal catheter?

Abstract

In this study, we investigate the occurrence rate of early shunt infection and malfunction in pediatric patients after converting an external ventricular drainage (EVD) to a ventriculo-peritoneal shunt (VPS) without replacing the ventricular catheter. Data was retrospectively reviewed for 17 pediatric patients (11 male (64.7%), mean age 7.5years, range 0.25-15years) who underwent 18 consecutive direct conversions of tunneled EVD to VPS without replacing the ventricular catheter between 2008 and 2017. In each case, the EVD was inserted in sterile fashion within the operating room and tunneled subcutaneously 5-7cm away from the insertion site. Primary outcome measure was the occurrence of early (within 30days) VPS infection or malfunction. The mean follow-up time was 56.8months (±35.7months). The mean period of EVD before VPS placement was 9.0days (±3.6days, range 2-18days). Five patients had shunt infections/malfunctions. One patient (5.6%) had an early shunt infection after 30days. One patient had a late shunt infection after 9months. One patient had an early shunt malfunction after 9days. Two patients (11.1%) had late shunt malfunctions after 6.5months and 9years. There were no other incidents of shunt-related complications or shunt-related mortality. In the pediatric population, the conversion of a tunneled EVD to a VPS without replacing the ventricular catheter can be safely done. Cranial entry is spared, while the rates of shunt infection and malfunction do not increase significantly.