scholarly journals Lumboperitoneal Shunt: A New Modified Surgical Technique and a Comparison of the Complications with Ventriculoperitoneal Shunt in a Single Center

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 643 ◽  
Author(s):  
Tsung-Hsi Yang ◽  
Cheng-Siu Chang ◽  
Wen-Wei Sung ◽  
Jung-Tung Liu
Keyword(s):  
Revision Rate ◽  
Shunt Infection ◽  
Shunt Malfunction ◽  
Single Center ◽  
Two Stage ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Programmable Valve ◽  
Shunt Group ◽  
Modern Era

Background and objectives: Hydrocephalus remains a disease requiring surgical treatment even in the modern era. Ventriculoperitoneal (VP) shunt placement is the most common treatment, whereas lumboperitoneal (LP) shunts are less commonly used due to initial reports of very high rates of complications. In the present study, we retrospectively reviewed our experience of the new two-stage procedure with LP shunt implantation to assess the complications and the results of this procedure versus VP shunt insertion. Materials and Methods: All patients from a single center who had received LP shunts using a Medtronic Strata device or VP shunts in the past six-year interval were retrospectively reviewed. The LP shunt insertion was a new two-stage procedure. We compared the three major complications and shunt revisions between the two groups, including shunt malfunction, infection, and subdural hematoma. Results: After matching the age and sex of both groups, we included 96 surgery numbers of LP shunts and 192 surgery numbers of VP shunts for comparison. In the LP shunt group, one patient (1.0%) underwent revision of the shunt due to shunt infection. In the VP shunt group, 26 surgeries (13.5%) needed revision, and 11 surgeries (5.7%) had shunt infection. Shunt malfunction occurred in 14 patients (7.3%) and all needed revisions. The revision rate showed statistically significant differences between the LP and VP shunt groups (p < 0.001). Conclusions: The recent improvements in the quality of the LP shunt device and the proficiency of the procedure has made the LP shunt a safer procedure than the VP shunt. The programmable valve can avoid overdrainage complications and reduce the revision rate. With our procedural steps, the LP shunt can be used to decrease the complications and revision rates.

Conversion of external ventricular drains to ventriculoperitoneal shunts after aneurysmal subarachnoid hemorrhage: effects of site and protein/red blood cell counts on shunt infection and malfunction

2008 ◽  
Vol 109 (6) ◽  
pp. 1001-1004 ◽  
Author(s):  
Stylianos Rammos ◽  
Jeffrey Klopfenstein ◽  
Lori Augsburger ◽  
Huan Wang ◽  
Anne Wagenbach ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Shunt Infection ◽  
Adult Patients ◽  
Shunt Malfunction ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
The Mean

Object The purpose of this study was to determine the incidence of shunt infection in patients with subarachnoid hemorrhage (SAH) after converting an external ventricular drain (EVD) to a ventriculoperitoneal (VP) shunt using the existing EVD site. The second purpose was to assess the risk of shunt malfunction after converting the EVD to a permanent shunt irrespective of the cerebrospinal fluid (CSF) protein and red blood cell (RBC) counts. Methods Data obtained in 80 consecutive adult patients (18 men and 62 women, mean age 60.8 years, range 33–85 years) who underwent direct conversion of an EVD to a VP shunt for post-SAH hydrocephalus between August 2002 and March 2007 were retrospectively reviewed. In each patient, the existing EVD site was used to pass the proximal shunt catheter. In no patient was VP shunt insertion delayed based on preoperative RBC or protein counts. Results The mean period of external ventricular drainage before VP shunt placement was 14.1 days (range 3–45 days). No patient suffered ventriculitis. The mean perioperative CSF protein level was 124 mg/dl (range 17–516 mg/dl). The mean and median perioperative RBC values in CSF were 14,203 RBCs/mm3 and 4600 RBCs/mm3 (range 119–290,000/mm3), respectively. No patient was lost to follow-up. The mean follow-up duration was 24 months (range 2–53 months). Three patients (3.8%) had shunt malfunction related to obstruction of the shunt system after 15 days, 2 months, and 18 months, respectively. There were no shunt-related infections. No patient suffered a clinically significant hemorrhage from ventricular catheter placement after VP shunt insertion. Conclusions In adult patients with aneurysmal SAH, conversion of an EVD to a VP shunt can be safely done using the same EVD site. In this defined patient population, protein and RBC counts in the CSF do not seem to affect shunt survival adversely. Thus, conversion of an EVD to VP shunt should not be delayed because of an elevated protein or RBC count.

scholarly journals Shunt infection and malfunction in patients with myelomeningocele

2021 ◽  
pp. 1-7
Author(s):  
Michael D. White ◽  
Michael M. McDowell ◽  
Nitin Agarwal ◽  
Stephanie Greene
Keyword(s):  
Infection Rate ◽  
Revision Rate ◽  
Shunt Infection ◽  
Research Network ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Shunt Infection Rate ◽  
Shunt Removal ◽  
Shunt Infections

OBJECTIVEMyelomeningocele (MMC) is frequently complicated by symptomatic hydrocephalus, necessitating early permanent CSF diversion and revision surgeries. Shunt infections are a common cause of shunt malfunction. This study aims to characterize long-term shunt-related outcomes of patients undergoing MMC closure.METHODSA total of 170 patients undergoing MMC closure between the years of 1995 and 2017 were identified from a retrospective review of a prospectively populated surgical database at the Children’s Hospital of Pittsburgh. Patients who underwent MMC closure and required ventriculoperitoneal (VP) shunt insertion met criteria and were included in the primary study analysis. Analysis with a Fisher exact test was performed for categorical variables, and Mann-Whitney U-tests were utilized for numerical data.RESULTSOf the 158 total patients undergoing MMC closure and meeting inclusion criteria, 137 (87%) required VP shunt insertion. These 137 patients demonstrated a shunt revision rate of 21.1% per person-year and a shunt infection rate of 2.1% per person-year over a mean follow-up of 10.8 years. Patients had a mean of 3.4 ± 0.6 shunt surgeries prior to their first infection. Patients undergoing immediate shunt removal, external ventricular drain placement, or shunt replacement after clearing the infection had lower rates of subsequent infections than patients who initially were managed with shunt externalization (p < 0.001). Placement of a shunt at the time of MMC closure was not found to be a risk factor for infection. Of patients with initial shunt placement after the implementation of the Hydrocephalus Clinical Research Network protocol in 2011, the authors’ institution has had a shunt infection rate of 4.2% per person-year and a revision rate of 35.7% per person-year.CONCLUSIONSThis study describes long-term outcomes of shunted MMC patients and factors associated with shunt infections. Most patients underwent multiple revisions prior to the first shunt infection. Shunt externalization may be ineffective at clearing the infection and should be avoided in favor of early shunt removal and external ventricular drainage, followed by shunt replacement once infection is demonstrated to have cleared.

Risk factors for unchanged ventricles during pediatric shunt malfunction

2021 ◽  
pp. 1-7
Author(s):  
Rebecca A. Reynolds ◽  
Ranbir Ahluwalia ◽  
Vishal Krishnan ◽  
Katherine A. Kelly ◽  
Jaclyn Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariable Analysis ◽  
Shunt Infection ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Diagnostic Dilemma ◽  
Wound Drainage ◽  
Abdominal Pseudocyst ◽  
Programmable Valve ◽  
Matched Case

OBJECTIVE Children whose ventricles do not change during shunt malfunction present a diagnostic dilemma. This study was performed to identify risk factors for unchanged ventricular size at shunt malfunction. METHODS This retrospective 1:1 age-matched case-control study identified children with shunted hydrocephalus who underwent shunt revision with intraoperative evidence of malfunction at one of the three participating institutions from 1997 to 2019. Cases were defined as patients with a change of < 0.05 in the frontal–occipital horn ratio (FOR) between malfunction and baseline, and controls included patients with FOR changes ≥ 0.05. The presence of infection, abdominal pseudocyst, pseudomeningocele, or wound drainage and lack of baseline cranial imaging at the time of malfunction warranted exclusion. RESULTS Of 450 included patients, 60% were male, 73% were Caucasian, and 67% had an occipital shunt. The median age was 4.3 (IQR 0.97–9.21) years at malfunction. On univariable analysis, unchanged ventricles at malfunction were associated with a frontal shunt (41% vs 28%, p < 0.001), programmable valve (17% vs 9%, p = 0.011), nonsiphoning shunt (85% vs 66%, p < 0.001), larger baseline FOR (0.44 ± 0.12 vs 0.38 ± 0.11, p < 0.001), no prior shunt infection (87% vs 76%, p = 0.003), and no prior shunt revisions (68% vs 52%, p < 0.001). On multivariable analysis with collinear variables removed, patients with a frontal shunt (OR 1.67, 95% CI 1.08–2.70, p = 0.037), programmable valve (OR 2.63, 95% CI 1.32–5.26, p = 0.007), nonsiphoning shunt at malfunction (OR 2.76, 95% CI 1.63–4.67, p < 0.001), larger baseline FOR (OR 3.13, 95% CI 2.21–4.43, p < 0.001), and no prior shunt infection (OR 2.34, 95% CI 1.27–4.30, p = 0.007) were more likely to have unchanged ventricles at malfunction. CONCLUSIONS In a multicenter cohort of children with shunt malfunction, those with a frontal shunt, programmable valve, nonsiphoning shunt, baseline large ventricles, and no prior shunt infection were more likely than others to have unchanged ventricles at shunt failure.

Breastfeeding: a potential protective factor against ventriculoperitoneal shunt infection in young infants

2008 ◽  
Vol 1 (2) ◽  
pp. 138-141 ◽  
Author(s):  
Farideh Nejat ◽  
Parvin Tajik ◽  
Syed Mohammad Ghodsi ◽  
Banafsheh Golestan ◽  
Reza Majdzadeh ◽  
...  
Keyword(s):  
Human Milk ◽  
Protective Factor ◽  
Medical Center ◽  
Shunt Infection ◽  
Trend Test ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Young Infants ◽  
Significant Difference ◽  
Nutritional Benefits

Object Previous studies have shown nutritional benefits of breastfeeding for a child's health, especially for protection against infection. Protective factors in human milk locally and systemically prevent infections in the gastrointestinal as well as upper and lower respiratory tracts. It remains unclear whether breastfeeding protects infants against ventriculoperitoneal (VP) shunt infection. Methods A cohort study was conducted from December 2003 to December 2006 at Children's Hospital Medical Center in Tehran, Iran. A total of 127 infants with hydrocephalus who were treated using a VP shunt in the first 6 months of life were enrolled. Each infant's breastfeeding method was classified as either exclusively breastfed (EBF), combination feedings of breast milk and formula (CFBF), or exclusively formula-fed (EFF). Infants were followed up to determine the occurrence of shunt infection within 6 months after operation. Statistical analysis was performed using survival methods. Results Infants ranged in age from 4 to 170 days at the time of shunt insertion (mean 69.6 days), and 57% were males. Regarding the breastfeeding categories, 57.5% were EBF, 25.2% were CFBF, and 17.3% were EFF. During the follow-up, shunt infection occurred in 16 patients, within 15 to 173 days after shunt surgery (median 49 days). The 6-month risk of shunt infection was 8.5% (95% confidence interval [CI] 4–18%) in the EBF group, 16.5% (95% CI 7–35%) in the CFBF group, and 26.0% (95% CI 12–52%) in the EFF group. There was no statistically significant difference between these 3 groups (p = 0.11). The trend test showed a significant trend between the extent of breastfeeding and the risk of shunt infection (p = 0.035), which persisted even after adjustment for potential confounding variables (hazard ratio = 2.01, 95% CI 1.01–4). Conclusions This study supports the protective effect of breastfeeding against shunt infection during the first 6 months of life and the presence of a dose–response relationship, such that the higher the proportion of an infant's feeding that comes from human milk, the lower the incidence of shunt infection. Encouraging mothers of infants with VP shunts to breastfeed exclusively in the first 6 months of life is recommended.

scholarly journals VP Shunt Complications: Ten Years Experience at UDMNINAS

2019 ◽  
Vol 16 (3) ◽  
pp. 40-42
Author(s):  
Subash Lohani ◽  
Aashish Baniya
Keyword(s):  
Retrospective Review ◽  
Pediatric Population ◽  
Shunt Infection ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Shunt Complication ◽  
Vp Shunt ◽  
Shunt Complications ◽  
International Data ◽  
Ventriculo Peritoneal Shunt

Ventriculo-Peritoneal shunt is significantly associated with complications like malfunction and infection. In this study, we aim to review our infection and malfunction rate. This is a retrospective review of charts of patients who underwent ventriculo-peritonealshunt at Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Nepal between 2008 and 2018. Patients were interviewed via telephone for information regarding shunt complications in the form of malfunction, infection, and the need for revision. A total of 357 patients underwent ventriculoperitonealshunt over a period of 10 years.   of patients was 37.08 years. There were224 males and133 females with M:F::1.7:1.265 patients were available over telephone for interview. 54 of 265 (20.37%) patients needed shunt revision. 32 (12.07%) of them had shunt malfunction. 21 (7.92%) of them had shunt infection. One (0.37%) patient had problems with over drainage. Shunt complications were proportionate in pediatric population as well. Shunt complication at Upendra Devkota Memorial National Institute of Neurological and Allied Sciences is comparable to international data.

scholarly journals A study of VP shunt in management of hydrocephalus

2017 ◽  
Vol 4 (5) ◽  
pp. 1697
Author(s):  
Sudhir Singh Pal ◽  
Saurabh Dubey
Keyword(s):  
Shunt Infection ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Chi Square ◽  
Vp Shunt ◽  
Shunt Complications ◽  
Medical College ◽  
Chi Square Test ◽  
Gandhi Medical College ◽  
Shunt Migration

Background: Hydrocephalus a neurological disorder common in both children and adults. VP shunt placement is considered the mainstay of management. The aim was to study complications of VP Shunt and factors influencing shunt malfunction and prognosis.Methods: This study was conducted in the Department of Surgery, Gandhi Medical College Bhopal, Madhya Pradesh, India between January 2013 to August 2016 and included all patients of hydrocephalus who underwent VP shunt surgery. We performed a retrospective and prospective data review which was subjected to statistical analysis, frequency determination, determination of mean and standard deviation, Pearson’s Chi-square test for studying associations between variables.Results: A total of 198 patients were studied. The predominant etiologies being congenital hydrocephalus, aqueduct stenosis, spina bifida/MMC, intracranial space occupying lesions and tuberculous meningitis. The incidence of overall shunt complications was 28.8%, incidence of shunt revision was 21.2%, shunt blockade 7.6%), shunt migration 5.05%, shunt infection 4.5%, and shunt malfunction due to other causes 8.6%. The mortality rate was 20.2%.  Factors associated with increased shunt complications included infective etiology of the hydrocephalus and CSF culture positivity in preoperative period.Conclusions: Infective and traumatic causes of hydrocephalus are more likely to be associated with complications like infection and obstruction. Shunt migration is seen in paediatric patients.

scholarly journals 438 Is Cerebrospinal Fluid Sampling Necessary at The Time of First Ventriculo-Peritoneal Shunt Insertion in Paediatric Patients?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C W L Chia ◽  
P Leach
Keyword(s):  
Cerebrospinal Fluid ◽  
Shunt Infection ◽  
Antibiotic Prescribing ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Patient Demographics ◽  
Paediatric Patients ◽  
Future Risk ◽  
Fluid Sampling

Abstract We aim to evaluate whether intraoperative cerebrospinal fluid (CSF) sampling during ventriculo-peritoneal (VP) shunt insertion can predict future shunt infection or guide its management, as there is currently no evidence for this. 83 paediatric patients undergoing VP shunt insertion between February 2013 and July 2019 were retrospectively identified. Patient demographics, presence of pre-operative extra ventricular drain (EVD), pre-operative CSF results, and intra-operative CSF results were identified. All patients were followed up for a minimum of 6 months for identification of shunt infection. 90 VP shunt insertions were performed in 83 patients. Age at time of shunt insertion ranged from 5 days to 15.8 years (mean 44.2 months). Tumours were the most common aetiology for hydrocephalus (n = 24). 67 cases (74.4%) had intra-operative CSF samples, of which 2 revealed the presence of bacteria. Only 1 patient with intraoperative CSF sampling positive for growth developed shunt infection during follow up. Two cases developed a shunt infection despite normal intra-operative CSF results. Three cases did not have intra-operative CSF sampling but developed a shunt infection during follow up. Our results show that intraoperative CSF sampling as a method to predict future risk of shunt infection and to help inform future antibiotic prescribing is unreliable.

scholarly journals The Complication for Ventricular Shunt Based on Different Etiologies: A Prospective Study in Tehran, Iran

2018 ◽  
Vol 12 (1) ◽  
pp. 57-63
Author(s):  
Mohammad Vafaee Shahi ◽  
Samileh Noorbakhsh ◽  
Sarvenaz Ashouri ◽  
Leila Tahernia ◽  
Maryam Raghami Derakhshani
Keyword(s):  
Cerebral Hemorrhage ◽  
Shunt Infection ◽  
P Value ◽  
Laboratory Findings ◽  
Shunt Insertion ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Vp Shunt ◽  
Mechanical Complications ◽  
Infectious Origin

Objectives:The purpose of this study was to evaluate and compare complications caused by VP shunt (based on imaging changes, clinical and laboratory findings) in children with congenital (intrauterine) infections, referred to as TORCH, in contrast to other causes of Shunt insertion in children.Materials and Methods:In this cross-sectional, observational and descriptive study, 68 hospitalized patients in Rasool-Akram Hospital were selected using convenience method during 2 years from 2013 to August, 2016. Clinical examination and organ involvement were determined. Blood sampling, serological and complementary tests were performed to determine the type of infection, cause and duration of shunt insertion, mechanical and infectious complications (meningitis and peritonitis), the course of the disease and finally, mortality and morbidity. All data were collected in questionnaires. Statistical analysis was performed using SPSS-24 version software. The comparison was carried out between two groups of infectious and noninfectious causes. P-value less than 5.5 was considered significant.Results:From total 68 children with VP shunt, 13 patients died (including 8 males and 5 females with a mean age of 69.41 ± 81.57 months-old). The main cause of shunt insertion was infection in 4 patients and tumor, cerebral hemorrhage and myelomeningocele in 9 other children. Shunt-induced meningitis and peritonitis were detected in 92% and 7.7% respectively. The leading causes of shunt insertion In remaining 47 live children (including 27 males and 19 females with a mean age of 63 +83 months) were infectious in 28% and noninfectious in the rest of cases. The shunt mechanical complications were reported in 8.7% (4 patients). Fever was detected in 33% of patients. Positive blood culture and cerebrospinal fluid were reported in 6.8% and 8.5% of patients in that order, but meningitis was detected in 26% (12 cases) and peritonitis in 10.9% (5 cases). Although, there were no significant differences between two groups in terms of mechanical complications such as shunt obstruction, cerebral hemorrhage ;but, a considerable difference was reported in death rate due to shunt insertion between two groups with infectious and noninfectious origin. The risk of shunt-induced meningitis was clearly higher in group with infectious origin. (P-value = 0.05). But peritonitis risk was not different.Conclusion:VP shunt complications were observed in one-quarter of children, but mechanical complications of VP shunt were uncommon (8% in live patients). VP shunt mortality was relatively high (13 patients from total 68), and occurred more often in patients with non-infectious causes of VP shunt, mainly due to meningitis. Shunt meningitis was very common In patients with infectious origin. Shunt infection in patients (meningitis, bacteremia and peritonitis) was common and could increase mortality if not controlled. Prescribing antibiotics is not recommended without initial diagnostic measures (such as spinal fluid puncture, ascites, and proper imaging) because it will result in incomplete and improper treatments.

Reliability of the radiopharmaceutical shunt flow study for the detection of a CSF shunt malfunction in the presence of stable ventricular size

2020 ◽  
Vol 26 (4) ◽  
pp. 364-370
Author(s):  
Jeffrey J. Quezada ◽  
J. Gordon McComb
Keyword(s):  
Ct Scan ◽  
Operative Intervention ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Technical Failure ◽  
Ventricular Size ◽  
Shunt Flow ◽  
Programmable Valve ◽  
Flow Study

OBJECTIVEThe authors sought to determine the reliability of a radiopharmaceutical (RP) shunt flow study for the detection of a CSF-diverting shunt malfunction in the presence of stable ventricular size.METHODSAfter the authors obtained IRB approval, all CSF RP shunt flow studies done between January 1, 2014, and January 1, 2019, in pediatric patients at Children’s Hospital Los Angeles were identified. Included in the study were only those patients in whom an MRI or CT scan was done during the hospital admission for shunt malfunction and showed no increase in ventricular size compared with the most recent prior MRI or CT scan when the patient was asymptomatic. Data recorded for analysis were patient age and sex, etiology of the hydrocephalus, shunt distal site, nonprogrammable versus programmable valve, operative findings if the shunt was revised, and follow-up findings for a minimum of 90 days after admission. The RP shunt flow study consisted of tapping the reservoir and injecting technetium-99m DTPA according to a set protocol.RESULTSThe authors identified 146 RP flow studies performed in 119 patients meeting the above criteria. Four of the 146 RP studies (3%) were nondiagnostic secondary to technical failure and were excluded from statistical analysis. Of the 112 normal flow studies, operative intervention was not undertaken in 102 (91%). The 10 (9%) remaining normal studies were performed in patients who underwent operative intervention, in which 8 patients had a proximal obstruction, 1 had a distal obstruction, and 1 patient had no obstruction. Of the 30 patients with abnormal flow studies, symptoms of shunt malfunction subsided in 9 (30%) patients and these patients did not undergo operative intervention. Of the 21 (70%) operated patients, obstruction was proximal in 9 patients and distal in 5, and for 7 patients the shunt tubing was either fractured or disconnected. Regression analysis indicated a significant association between the flow study interpretation and the odds for shunt revision (OR 27, 95% CI 10–75, p < 0.0001). No other clinical variables were significant. The sensitivity of a shunt flow study alone for detection of shunt malfunction in cases with stable ventricular size was the same as a shunt flow study plus an MRI or CT (70% vs 70%), but performing a shunt flow in addition to MRI or CT did increase the specificity from 92% to 100% and the accuracy from 87% to 94%.CONCLUSIONSRP shunt flow studies were of definite value in deciding whether to operatively intervene in patients with symptoms of shunt malfunction in whom no change in ventricular size was detected on current MRI or CT scans compared to scans obtained when the patients were asymptomatic.

Ventricular reservoirs and ventriculoperitoneal shunts for premature infants with posthemorrhagic hydrocephalus: an institutional experience

2009 ◽  
Vol 3 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Brian Willis ◽  
Vijayakumar Javalkar ◽  
Prasad Vannemreddy ◽  
Gloria Caldito ◽  
Junko Matsuyama ◽  
...  
Keyword(s):  
Birth Weight ◽  
Surgical Treatment ◽  
Premature Infants ◽  
Preterm Neonates ◽  
Posthemorrhagic Hydrocephalus ◽  
Vp Shunt ◽  
Shunt Group ◽  
Institutional Experience ◽  
Csf Diversion ◽  
The Mean

Object The aim of the study was to analyze the outcome of surgical treatment for posthemorrhagic hydrocephalus in premature infants. Methods From 1990 to 2006, 32 premature infants underwent surgical treatment for posthemorrhagic hydrocephalus, and their charts were retrospectively reviewed to analyze the complications and outcome with respect to shunt revisions. Multivariate analysis and time series were used to identify factors that influence the outcome in terms of shunt revisions. Results The mean gestational age was 27 ± 3.3 weeks, and mean birth weight was 1192 ± 660 g. Temporary reservoir placement was performed in 15 patients, while 17 underwent permanent CSF diversion with a ventriculoperitoneal (VP) shunt. In 2 patients, reservoir tapping alone was sufficient to halt the progression of hydrocephalus; 29 patients received VP shunts. The mean follow-up period was 37.3 months. The neonates who received VP shunts first were significantly older (p = 0.02) and heavier (p = 0.04) than those who initially underwent reservoir placement. Shunts were revised in 14 patients; 42% of patients in the reservoir group had their shunts revised, while 53% of infants who had initially received a VP shunt required a revision. The revision rate per patient in the reservoir group was half that in the direct VP shunt group (p = 0.027). No patient in the reservoir group had > 2 revisions. Shunt infections developed in 3 patients (10.3%), and 2 patients in the reservoir group died of nonneurological issues related to prematurity. Conclusions Birth weight and age are useful parameters in decision making. Preterm neonates with low birth weights benefit from initial CSF drainage procedures followed by permanent CSF diversion with respect to the number of shunt revisions.

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