This study aims to assess the survival outcomes of ventriculo-peritoneal shunt (VPS) and identify risk factors for shunt failure when using the standardized protocol in Vietnamese children. This was a multi-center retrospective cohort study at four pediatric centers in Vietnam. All patients less than 16years old who underwent initial VPS placement between 2021 and 2024 were included. The Kaplan-Meier method was employed for survival analysis. Risk factors were identified using Cox regression models. A total of 334 individuals were enrolled with a median follow-up (FU) of 21months. Brain tumors (59.6%), post-meningitis (14.7%), and congenital abnormalities (14.3%) were the most common etiologies of hydrocephalus. Shunt infection rate was 14.1%. Low rate of full compliance with protocol (39.5%) increased shunt infection (p = 0.01). The 1-, 2-, and 3-year overall survival (OS) of VPS was 69%, 64%, and 61%, respectively, with an estimated mean survival time (ST) of 26months. Post-meningitis hydrocephalus, non-compliance with shunt protocol, and improper technique were independent risk factors for shunt failure with adjusted hazard ratios (95% confidence interval) (aHR [CI]) of 1.82 (1.09-3.03), 1.69 (1.08-2.64), and 5.57 (2.90-10.69), respectively. The shunt survival outcomes in Vietnamese children remain consistent with those in other populations in similar settings. Post-meningitis hydrocephalus, non-compliance, and improper technique are independently associated with reduced shunt survival. Recommendations include standardizing surgical techniques and ensuring full compliance with shunt protocol to prevent infection and improve shunt outcomes. This study also underscores the feasibility and efficiency of implementing the standardized shunt protocol in resource-limited countries.

To assess whether switching valve type or valve brand during shunt revision affects clinical outcomes in pediatric patients with hydrocephalus. Patients at two centers who were younger than 26years of age, underwent a cerebrospinal fluid (CSF) shunt revision involving a valve change, were alive at discharge, and had at least one documented clinical follow-up within 30days were retrospectively reviewed. Patients who were implanted with a different valve type (fixed vs programmable) or brand during the shunt revision were compared to those who maintained the same valve type or brand. The rates of shunt obstruction, infection, overdrainage, reoperation, readmission, and other complications were analyzed. Fifty-five patients undergoing 67 shunt revisions involving the valve met the inclusion criteria. Short-term (30-day) complication profiles were similar (p = 0.626) when the valve was replaced with another valve of the same type (n = 31) versus when a different type was implanted (n = 36). Among patients for whom the same valve type was maintained, there were no significant differences in postoperative complications when the fixed-pressure valve brand was changed (n = 7) compared to when the same brand was replaced (n = 12) (p = 0.678). Changing the programmable valve brand (n = 6) resulted in a significantly lower rate of complications (p = 0.025), specifically fewer frequent shunt obstructions (p = 0.025), compared to when the same programmable valve brand was replaced (n = 11). In this two-center cohort of shunt revisions involving the valve, changing the valve type or brand was not associated with differences in early (30-day) complication rates. A significant trend toward fewer complications after changing the programmable valve brand was observed in a small subgroup and should be interpreted as hypothesis-generating. Larger, longer-term studies are needed to determine the impact of valve choice on shunt survival and long-term outcomes.

This study aims to identify epidemiological, microbiological, and laboratory characteristics of cerebrospinal fluid (CSF) shunt infections in children and evaluate associated risk factors. Patients aged 0-18 years who underwent ventricular shunt placement at Gazi University Faculty of Medicine Hospital between January 1, 2010, and December 31, 2022, were retrospectively reviewed. A total of 201 shunt procedures performed in 176 patients were analyzed, with infection occurring in 32 cases (15.9%). Infection rates were higher in subgaleal shunts (60%) than ventriculoperitoneal shunts (15.2%) (p = 0.018). Shunt infections developed in 31.7% of procedures involving at least one risk factor, compared with 5.7% of procedures without identified risk factors (p < 0.001). Preterm infants (<37 wks) had a higher infection rate (49%) than those born ≥37 weeks (14.5%) (p < 0.001). Gram-positive microorganisms accounted for 56.3% of infections, most commonly Staphylococcus sp., whereas Pseudomonas aeruginosa and Klebsiella species were the most frequent gram-negative pathogens (each 12.5%). Patients with gram-negative meningitis had a significantly higher intensive care unit admission rate than those with gram-positive meningitis (p = 0.021). In multivariate analysis, subgaleal shunt placement was associated with increased odds of shunt infection (OR: 12.13; CI: 1.36-107.69) (p = 0.025). In regression analysis, preterm birth was independently associated with an increased risk of shunt infection (OR: 6.12; CI: 2.02-18.56). Shunt infection rates and microbial patterns align with existing literature. Preterm birth emerged as a major risk factor for shunt infection, whereas subgaleal shunt placement appeared to be a potential risk factor that warrants cautious interpretation and further validation. The increased severity of gram-negative infections underscores the need for stringent monitoring and preventive strategies in high-risk populations.

Ventricular reservoir infections and cerebrospinal fluid (CSF) shunt infections are diagnosed when bacteria are recovered from microbiological cultures of CSF samples from these devices. We applied high throughput sequencing (HTS) to understand the course of changes in ventricular reservoir and shunt infection microbiota. Evaluate the utility of monitoring microbiota in CSF (1) from ventricular reservoirs to detect development of an infection and (2) during treatment of CSF shunt infections to assess treatment response. Study populations included (1) neonates with temporizing ventricular reservoirs who developed reservoir infection and (2) children undergoing treatment for conventional culture-confirmed CSF shunt infection. The V4 region of the 16S ribosomal RNA gene was amplified and sequenced. Comparison of taxonomic results of HTS with standard microbiological culture results (when available) was described for each CSF sample. A robust HTS signal was defined by a microbial load of ≥1e5 microbial genome equivalents/mL. In none of the five ventricular reservoir infection cases was there a robust HTS signal for the responsible bacteria immediately prior to infection. In six of the seven CSF shunt infection cases, there was a robust HTS signal for the genus of the responsible bacteria in the sample at the time of positive CSF culture. The proportion of sequences from the genus associated with the responsible bacteria decreased during infection treatment. These pilot data suggest limited utility in using HTS for surveillance for ventricular reservoir infections, as they emerge abruptly. In CSF shunt infection, HTS demonstrates a return to heterogeneous microbiota when bacterial cultures become negative.

To report a case of bilateral macular neovascularization (MNV) secondary to septic embolism from a shunt infection. Observational case report. A 57-year-old female on maintenance hemodialysis experienced cardiac arrest due to sepsis and was resuscitated with an automated external defibrillator. Blood cultures grew methicillin-sensitive Staphylococcus aureus (MSSA). Echocardiography showed no evidence of infective endocarditis (IE); a pseudoaneurysm of the shunt vessel was identified as the likely source of infection. Chest computed tomography revealed a septic pulmonary embolus. Three weeks later, the patient developed metamorphopsia in the right eye. Visual acuity at presentation was 20/25 (right) and 20/20 (left). Ophthalmological evaluation, including optical coherence tomography (OCT) and OCT angiography, confirmed bilateral type 2 MNV. She received intravitreal aflibercept injections in both eyes, which reduced MNV activity and improved symptoms. No recurrence occurred over one year of follow-up. Bilateral MNV can develop in patients with sepsis due to shunt infection without evidence of IE. This case underscores the need to consider MNV as a potential complication not only in IE-related sepsis but also in sepsis from other sources, such as shunt infections.

Patients with severe brain injury requiring decompressive craniectomy are at increased risk of developing chronic hydrocephalus, often necessitating both cranioplasty and shunt surgery. The optimal sequence of these procedures remains unclear, with limited and conflicting evidence on associated complication rates and outcomes. The aim of this study was to investigate clinical practices and outcomes associated with 3 procedural sequences: (1) cranioplasty before shunt, (2) simultaneous cranioplasty and shunt, and (3) shunt before cranioplasty. In this multicenter retrospective cohort study, 99 patients from 4 Swedish neurosurgical centers who underwent both cranioplasty and shunt surgery over 15 years (2008-2022; only the first 10 years at 1 center) were included. Clinical data, surgical details, complications, and functional outcomes (modified Rankin Scale) were analyzed by each sequence group. Of 99 patients, 37 (37%) underwent cranioplasty before shunt, 37 (37%) had simultaneous procedures, and 25 (25%) received a shunt before cranioplasty. There was no significant difference in complications rates after cranioplasty or shunt surgery between these groups (P > .05). However, shunt before cranioplasty was associated with slightly higher rates of shunt complications (36% revision) but lower rates of cranioplasty removal (8%), whereas the inverse pattern was observed in the cranioplasty before shunt group (24% shunt revision; 30% cranioplasty removal). There was no difference in functional outcomes before or after cranioplasty or shunt surgery between the groups (P > .05). The sequence of cranioplasty and shunt surgery did not significantly influence overall risks of implant revision or functional outcome, although complication patterns and their clinical severity differed between approaches. Cranioplasty implant removal remains a particularly serious event, while shunt infections can be equally detrimental. Future studies should refine sequencing strategies considering hydrocephalus type, timing, and procedural factors to minimize risk and improve patient outcomes.

The pediatric neurosurgical literature supports the placement of a ventricular access device (VAD) in the premature infant with posthemorrhagic ventricular dilatation as a temporizing measure prior to definitive diversionary shunting. However, there is an absence of data identifying the clinical utility and significance of VADs left in situ at the time of permanent shunt placement. The potential risks of leaving an initial VAD at the time of definitive contralateral cerebral spinal fluid (CSF) diversion and the benefits of a concomitant VAD in these patients with regard to potential life-saving or temporizing aspirations are not well documented. Retrospective cohort review of premature infants (< 37weeks gestational age) treated for PHH at a tertiary pediatric neurosurgery center from January 2005 to December 2021. Patients were grouped by whether a previously placed VAD was retained during permanent shunt insertion. number and outcome of VAD taps, shunt revisions, shunt infections. Statistical comparison between the two groups; p < 0.05 considered significant. Seventy-two premature patients (gestational age < 37weeks) were identified. This cohort included 40 (55.55%) patients with both a VAD and shunt and 32 (44.44%) patients with a shunt only (12 with VAD removed at shunt insertion; 20 with no VAD insertion). Of the 40 patients with a shunt and VAD in situ, 17/40 (42.5%) had their VADs tapped at the time of shunt failure, resulting in 29 total VAD taps. There were 23 emergent VAD taps, of which 17/23 (73.91%) were successful. Leaving the VAD in situ did not result in increased rates of total shunt infections or revisions (p = 0.215; p = 0.129). Based on this analysis, VADs placed for initial management of post-hemorrhagic IVH may serve an important role in children with subsequent proximal shunt malfunctions, potentially lifesaving. A high percentage of shunted patients with VADs benefited without increased risk of shunt revisions or infections. The decision for a VAD to remain in situ at the time of permanent shunt placement in these patients should be strongly considered.

Background/Objectives: There is limited evidence of a combination of intraventricular injection and shunt soaking with a vancomycin-gentamicin technique as a prophylaxis for shunt infection. This study aimed to evaluate if a combination of this prophylaxis technique was a potential strategy in preventing ventriculoperitoneal (VP) shunt infection. Factors associated with VP shunt infection at one year were executed by using logistic regression analysis. Methods: This was a retrospective cohort study. The inclusion criteria were consecutive patients who received VP shunt placement regardless of etiology. The primary outcome of this study was VP shunt infection at one year postoperatively. Results: During the study period, there were 413 patients who met the study criteria. Of those, 31 patients (7.51%) had an infected VP shunt one year after the operation. There were three factors that were independently associated with VP shunt infection at one year: age, etiology of brain tumor, and intraventricular injection and shunt soaking technique. The adjusted odds ratio of age and brain tumor was 0.974 (95% confidence interval of 0.960, 0.986) and 0.251 (95% confidence interval of 0.099, 0.640), while intraventricular injection and shunt soaking technique had an adjusted odds ratio of 0.422 (95% confidence interval of 0.212, 0.768). Conclusions: A combination of intraventricular injection and shunt soaking technique with vancomycin and gentamicin may lower the VP shunt infection rate at one year after operation. Younger patients under an age of 8 years may be at risk for VP shunt infection. Further prospective randomized controlled trial may be needed to confirm the results of this study.

Ultra-Late shunt infection in the paediatric population.

The aim of this study was to determine the clinical and health economic impact of the British Antibiotic and Silver Impregnated Catheters for ventriculoperitoneal Shunts (BASICS) trial on UK shunt surgery practice and shunt infection rates. This retrospective study used UK Shunt Registry data to compare antibiotic and standard shunt use in patients undergoing the first insertion of a ventriculoperitoneal shunt during pre-BASICS (January 2004 to June 2013) and post-BASICS (January 2018 to December 2021) periods. Patients of any age with hydrocephalus who underwent a primary ventriculoperitoneal shunt insertion were included. The percentage of antibiotic shunts inserted was the primary outcome, and the revision rate for infection was the secondary outcome. A budget impact analysis was performed to estimate the cost savings from reduced shunt infection. Across the study period, 12,476 patients (22% pediatric patients) underwent primary shunt insertions with 1226 revisions across 36 centers. Antibiotic shunt use increased from 36.9% in pediatric patients and 20.5% in adults in 2004, to 99.2% in pediatric patients and 96.8% in adults in 2021. The largest change was from 2018 to 2019 (year of BASICS reporting), with a 14.9% and 27.2% increase for pediatric and adult patients, respectively. Compared with standard shunts, the infection rate for antibiotic shunts was significantly lower in both pediatric (5.1% vs 1.9%, p < 0.001) and adult (1.5% vs 0.9%, p = 0.031) patients. Antibiotic shunts saved the NHS an estimated £1,004,572 (95% CI £738,496-£1,270,648) per year. BASICS has been followed by evident change in UK neurosurgical practice. Antibiotic shunts are the first choice for patients, with reduced infection and cost savings of approximately £1 million per year.

Ventriculoperitoneal shunt (VPS) placement remains the primary treatment for hydrocephalus. However, the literature on this topic is heterogeneous, with studies assessing and reporting surgical and clinical outcomes in different ways, lacking standardization. The authors aimed to evaluate the quality of these studies and propose a reporting guideline focusing on essential elements to ensure reproducibility and comparability. Following PRISMA guidelines, the authors systematically searched PubMed, Embase, Web of Science, and the Cochrane Library databases. Eligible studies were observational or randomized, reported clinical and/or surgical outcomes related to the treatment of hydrocephalus with VPS placement, included more than 200 patients, and were published in the English language between January 1, 2000, and June 1, 2024. Studies were assessed and focused on 6 key domains: 1) baseline characteristics of the patient sample; 2) study methodology and reporting guidelines; 3) patient comorbidities and clinical status; 4) valve and shunt characteristics; 5) shunt failure, revision, and infection; and 6) postsurgical outcomes and complications. Forty-five studies comprising 95,597 patients were included. The authors' assessment revealed substantial gaps in the literature on VPS placement, including deficiencies across all domains. A VPS reporting guideline was developed, consisting of 50 items distributed across 6 domains, focusing on key surgical and clinical outcomes. This review identified important gaps in methodological rigor and reporting across VPS studies for hydrocephalus, limiting the comparability and reproducibility of current evidence. To address these issues, the authors propose the VPS Reporting Guideline, a practical framework to enhance transparency, reproducibility, and comparability in future research, ultimately supporting better evidence synthesis and building of cumulative evidence.

Acinetobacter baumannii ventriculoperitoneal shunt infection in the pediatric population: Clinical assessment and microbiological profile

Fetal surgery for myelomeningocele is not yet standard practice in Japan. To establish baseline data for the outcomes of standard postnatal care for patients eligible for fetal surgery, we compared the results from our large, single-institution cohort with those of the Management of Myelomeningocele Study trial's postnatal group. We retrospectively reviewed 65 patients who underwent postnatal myelomeningocele repair at our center between 2002 and 2021. In our cohort, the myelomeningocele lesion level was thoracic in 18% of patients, L1-L2 in 12%, and L3 or below in 69%. Key outcomes, including the rate of cerebrospinal fluid shunt placement at 12 months and ambulation status at 30 months, were compared to the published data from the Management of Myelomeningocele Study postnatal cohort. The rate of cerebrospinal fluid shunt placement in our cohort (88%) and ambulation rates at 30 months (28%) showed no statistically significant difference from the Management of Myelomeningocele Study postnatal group (83%, p = 0.39, and 20%, p = 0.29, respectively). Our cohort had a significantly lower rate of shunt infection (0% vs. 9%, p = 0.02). However, the rates of surgery for symptomatic Chiari II malformation (18% vs. 5%, p = 0.01) and for tethered cord syndrome (9% vs. 1%, p = 0.03) were significantly higher in our cohort. The outcomes of modern postnatal myelomeningocele repair at a major Japanese center are largely consistent with the international benchmark set by the Management of Myelomeningocele Study trial. This study provides an essential baseline of data that will be indispensable for counseling families and for the objective evaluation of fetal surgery as it is introduced in Japan.

Effect of Nursing Care on Postoperative Ventriculoperitoneal Shunt Infection in Pediatric Patients with Hydrocephalus

Lumbar-peritoneal shunt-associated meningitis and peritoneal abscess due to Corynebacterium striatum: A case report and literature review.

Abstract Objective Ventriculoperitoneal (VP) shunt infections are prevalent and have significant negative prognostic impacts on both individuals and the healthcare systems. This institutional observational study’s main objectives were to ascertain the prevalence of shunt infections and investigate the associated risk factors, identify microbiological pathogens, and asses antibiotic susceptibility patterns in treated patients. Methods This single-centred prospective observational cohort analysis included patients undergoing ventriculoperitoneal shunt surgeries within three years. Patients were followed for atleast one year until reaching the primary endpoint of the shunt infection. The review and analysis of data on demographic, clinical, and surgical characteristics were done in this study. Cerebrospinal fluid (CSF) and shunt tube samples from cases undergoing shunt revision were sent for culture examination to identify the bacterial pathogens and investigate the prevailing patterns of antibiotic susceptibility. Univariate and multivariate analyses were utilized to investigate relationships among variables contributing to shunt infection. Results During the study period, 336 ventriculoperitoneal shunt procedures were completed. Of those, 96 cases (28.57%) involved shunt revisions, and 37 of those cases’ shunt revisions (11.01%) were brought on by infections. Fever (59.45%) and headache (70.27%) were the two most typical symptoms in patients with shunt infections. Variables like post-traumatic hydrocephalus, post-hemorrhagic hydrocephalus, infantile age, and longer surgery durations &gt; 75 min were linked significantly ( p &lt; 0.05) to the bacterial infection. It was determined that neither the surgical environment nor the clinical background of the surgeon correlated directly with the incidence of shunt infections. The most prevalent isolated bacteria was found to be Staphylococcus aureus (64.9%). Furthermore, bacterial strains exhibited higher susceptibility to imipenem compared to commonly employed quinolones and cephalosporins. Conclusions Shunt infections often manifest early signs within months and demand prompt attention. According to our intensive research on risk factors, shunt infection has more prevalence in people with post-traumatic and posthemorrhagic hydrocephalus. Prolonged surgical durations and infancy are both at an elevated risk of infection. Given these predisposing risk factors, prioritized attention and vigilance should be placed on these sensitive cases. In order to effectively prevent and treat shunt infections, it is recommended that institutions implement and adhere to comprehensive antibiotic policies. These policies should be carefully formulated to address the specific challenges associated with managing and controlling infections related to ventriculoperitoneal shunt procedures.

Abstract: Background: Hydrocephalus is a common pediatric neurosurgical condition. Timely surgical intervention is critical to prevent permanent neurological damage. Available research highlights the importance of optimal surgical timing. However, global data is limited, and local populations remain understudied. Objective: To determine the impact of timing of surgical intervention on short-term postoperative outcomes in pediatric patients with hydrocephalus. Materials and Methods: This retrospective observational study was conducted at the Pediatric Neurosurgery Department of the Children’s Hospital and the Institute of Child Health, Multan, from January 2024 to March 2025. From the hospital record, data of 83 children aged 1 month to 12 years diagnosed with hydrocephalus and who underwent surgical intervention were analyzed using non-probability consecutive sampling. Children were categorized into early (≤7 days) and delayed (&gt;7 days) intervention groups based on timing from diagnosis to surgery. Short-term outcomes like post-intervention complications, length of hospital stay, readmission, and mortality, were evaluated. Data analysis was performed using SPSS version 26.0. Descriptive and inferential statistics were applied, taking p&lt;0.05 as statistically significant. Result: Of the 87 patients, 48 (55.2%) were female. The median age was 5.42 (IQR: 3.00–8.67) years. Early intervention was performed in 47 (54.0%) and delayed in 40 (46.0%) patients. Enlarged head (46.8% vs. 25.0%, p=0.036) and poor feeding (55.3% vs. 32.5%, p=0.033) were more common in early group, while seizures were more prevalent in delayed group (6.4% vs. 25.0%, p=0.015). Median hospital stay was significantly shorter in early group (5.00 vs. 8.00 days, p&lt;0.001). Readmission was significantly lower in early group (4.3% vs. 17.5%, p=0.043). Although shunt malfunction, infection, and day-30 mortality were lower in early group, differences were not statistically significant. Conclusion: Early surgical intervention in pediatric hydrocephalus was significantly associated with shorter hospitalization and relatively lower early readmission rates, and potentially associated with fewer complications and mortality. Keywords: Children, hydrocephalus, mortality, readmission, seizures, Etiology.

A 64-year-old, previously healthy woman underwent repeated shunt removal and reinsertion for shunt dysfunction due to hydrocephalus. Mycobacterium fortuitum was detected in the culture solution at the end of the removed lumboperitoneal shunt approximately one year before the diagnosis; however, the result was considered to represent environmental contamination. The patient was hospitalized because of a high-grade fever, and M. fortuitum was detected in two blood cultures and a cerebrospinal fluid culture. We diagnosed the patient with disseminated nontuberculous mycobacterial infection due to M. fortuitum and removed the ventriculoatrial shunt. Multiple antimicrobial agents (imipenem/cilastatin, linezolid, ciprofloxacin, and trimethoprim/sulfamethoxazole) were administered for approximately two months, and the symptoms improved.

Fungal Infections of Cerebrospinal Fluid Shunt in Pediatric Patients: A Systematic Literature Review With a Case Report.

Abstract INTRODUCTION Cerebral ventriculitis is a life-threatening infection of the ventricular system, frequently arising after external ventricular drain (EVD) placement or shunt surgery, and carries high morbidity and mortality despite systemic and intraventricular antibiotics. Ventricular lavage (VL) has been proposed to actively clear infected CSF and debris, but its comparative benefit over conventional EVD ± antibiotics remains unclear. We aim to systematically compare clinical and biochemical outcomes of ventricular lavage versus conservative treatment (EVD ± antibiotics) in patients with cerebral ventriculitis. METHODS A PRISMA-guided search of PubMed, Cochrane Library, and ClinicalTrials.gov was conduction from inception till January 19, 2025, which identified randomized controlled trials and cohort studies comparing VL with conservative therapy in ventriculitis patients. Key outcomes included mortality, length of hospital stay, neurological status (GCS/mRS), CSF parameter normalization, need for CSF diversion (EVD/shunt), cerebral abscess, hydrocephalus, and shunt infections. Three reviewers screened and extracted data; quality was appraised using Cochrane ROB tools. Owing to study heterogeneity, a narrative synthesis was performed. RESULTS Fourteen studies (total n = 322) met inclusion criteria. VL was associated with lower mortality (0–25% vs. 23.5–52.9%), a mean reduction in hospital stays of 20–22 days, and higher rates of favorable functional outcome (mRS ≤ 3 in 66.7–68.8% vs. 23.5–25%) compared to controls. CSF leukocyte counts normalized in 4 days versus 12 days in control group, and protein levels in 12.9 days versus 27.2 days. Shunt dependency ranged 56–91% with VL versus 100% conservatively, and VL groups experienced fewer shunt infections (2 vs. 7 cases). CONCLUSION Ventricular lavage yields superior survival, faster infection clearance, shorter hospitalization, and improved neurological outcomes compared to conservative management of cerebral ventriculitis. These findings support VL as an adjunct to antibiotics in appropriate patients, though further trials are needed to refine its role.