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Paediatric ventriculoperitoneal shunt failures: 12-year experience from a Singapore children’s hospital

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Abstract

Purpose

Cerebrospinal fluid (CSF) shunt failures in children are devastating. The primary aims of this study are to, firstly, review our institutional series of ventriculoperitoneal shunt (VPS) insertions and identify factors associated with shunt failure.

Methods

This is a single-institution, retrospective study conducted over a 12-year period. All patients under 18 years old with VPS inserted were included. Variables of interest such as patient characteristics, hydrocephalus aetiology, shunt implant details, and outcomes were subjected to statistical analyses.

Results

A total of 214 VPS patients were selected for this study. The mean age at VPS insertion was 6 months with a mean follow-up duration of 44 months. The most common type of hydrocephalus was obstructive (n = 142, 66.4%), and the most frequent aetiology was tumour-related (n = 66, 30.8%). The 30-day shunt failure rate was 9.3%: 9 infections (4.2%), 7 occlusions (3.3%), and 4 others (1.9%). After multivariable analysis, only recent central nervous system (CNS) infection prior to VPS insertion remained significant (OR 15.4 (1.3–175), p = 0.028).

Conclusion

This is the first, large-scale local study focused on the shunt failure in Singaporean children. Significant findings in our study demonstrate that recently treated CNS infection is a factor associated with 30-day shunt failure while the values of CSF constituents were not contributory.

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Availability of data and materials

All data generated or analysed during this study are included in this published article and supplementary material.

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Authors and Affiliations

  1. Neurosurgical Service, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Jia Xu Lim, Hui Ping Han, Yi Wen Foo, Lee Ping Ng, David Chyi Yeu Low, Wan Tew Seow & Sharon Yin Yee Low

  2. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Block MD11, Clinical Research Centre, #02-03 (c/o CBmE Office), 10 Medical Drive, Singapore, 117597, Singapore

    Yiong Huak Chan

  3. Department of Neurosurgery, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore, 208433, Singapore

    David Chyi Yeu Low, Wan Tew Seow & Sharon Yin Yee Low

  4. SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11, Jalan Tan Tock Seng, Singapore, 308433, Singapore

    David Chyi Yeu Low, Wan Tew Seow & Sharon Yin Yee Low

  5. SingHealth Duke-NUS Paediatrics Academic Clinical Program, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Sharon Yin Yee Low

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  1. Jia Xu Lim
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Contributions

All authors have read and approved the manuscript. Conceptualization: Jia Xu Lim, Sharon YY Low. Data curation: Lee Ping Ng, Hui Ping Han, Yi Wen Foo. Formal analysis: Yiong Huak Chan, Jia Xu Lim. Investigation: Yiong Huak Chan, Jia Xu Lim. Methodology: Jia Xu Lim, Sharon YY Low. Project administration: Sharon YY Low. Resources: David CY Low, Wan Tew Seow, Sharon YY Low. Validation: Yiong Huak Chan, Jia Xu Lim, Sharon YY Low. Writing—original draft: Jia Xu Lim. Writing—review and editing: Sharon YY Low.

Corresponding author

Correspondence to Sharon Yin Yee Low.

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Ethics approval and consent to participate

This study is approved by the hospital ethics review board (Reference: Singhealth CIRB 2020/2416). The consent to publish is included as part of the written, informed consent form in this study.

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Participants and/or their legal guardians signed a written consent for this study. The consent to publish has been included as part of the study.

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The authors declare no conflict of interest.

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Supplementary Information

Below is the link to the electronic supplementary material.

381_2023_6007_MOESM1_ESM.docx

Supplementary file1 Supplementary Table 1: Adjusted CSF results for shunt occlusion and infection at timepoints of interest. (DOCX 16 KB)

381_2023_6007_MOESM2_ESM.docx

Supplementary file2 Supplementary Table 2: Summary of subgroup of patients with shunt infections. (Of note, ‘proximal infections’ are defined as infections of the ventricular catheter and/or shunt valve, while ‘distal infections’ are defined as infections of the peritoneal catheter). (DOCX 17 KB)

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Lim, J.X., Han, H.P., Foo, Y.W. et al. Paediatric ventriculoperitoneal shunt failures: 12-year experience from a Singapore children’s hospital. Childs Nerv Syst 39, 3445–3455 (2023). https://doi.org/10.1007/s00381-023-06007-x

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