World neurosurgery · 2026
Ventriculo-Abdominal Subcutaneous Tunneled External Drainage as a Transition Therapy to Reduce Shunt Failure Rate in Post-Infection Hydrocephalus Patients: A Single-Center Retrospective Cohort Study.
СтатьяНазвание и аннотация: Перевод в очереди
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Yao Long, Shen Liyi, Liu Xiaolei, Fu Jidi, Pan Dongchao
Аннотация
OBJECTIVE: Assess the clinical efficacy of Ventriculo-Abdominal Subcutaneous Tunneled External Drainage (VASTED) as a transition treatment before ventriculoperitoneal shunt (VPS) in the management of postinfectious hydrocephalus (PIH).
METHODS: This study enrolled 384 patients who developed PIH after craniotomy. Following external ventricular drainage and combined intravenous antibiotic therapy, patients underwent VASTED as a transitional treatment measure before definitive VPS placement when they achieved 3 consecutive negative cerebrospinal fluid bacterial cultures within 2 weeks and no pathogen detection by metagenomic next-generation sequencing. The primary endpoint of the study was the shunt failure rate after 1 year of follow-up, with infection and catheter blockage as the evaluation criteria.
RESULTS: A total of 378 cases underwent VPS surgery, with 6 cases refusing or abandoning treatment. During a 1-year follow-up period, 9 shunt failures occurred (2.38%, 95% confidence interval: 0.43-3.05). Among these, 5 failures were infection-related (1.3%) and 4 were due to pure mechanical obstruction (1.1%). The shortest duration of VASTED was 14 days, while the longest was 387 days, with a median drainage time of 69 days (95% confidence interval: 28-112 days).
CONCLUSIONS: In patients with PIH, implementing VASTED as a transitional surgical treatment approach is closely associated with an extremely low 1-year failure rate of VPS. This transitional strategy can significantly reduce the high failure rate following VPS.
METHODS: This study enrolled 384 patients who developed PIH after craniotomy. Following external ventricular drainage and combined intravenous antibiotic therapy, patients underwent VASTED as a transitional treatment measure before definitive VPS placement when they achieved 3 consecutive negative cerebrospinal fluid bacterial cultures within 2 weeks and no pathogen detection by metagenomic next-generation sequencing. The primary endpoint of the study was the shunt failure rate after 1 year of follow-up, with infection and catheter blockage as the evaluation criteria.
RESULTS: A total of 378 cases underwent VPS surgery, with 6 cases refusing or abandoning treatment. During a 1-year follow-up period, 9 shunt failures occurred (2.38%, 95% confidence interval: 0.43-3.05). Among these, 5 failures were infection-related (1.3%) and 4 were due to pure mechanical obstruction (1.1%). The shortest duration of VASTED was 14 days, while the longest was 387 days, with a median drainage time of 69 days (95% confidence interval: 28-112 days).
CONCLUSIONS: In patients with PIH, implementing VASTED as a transitional surgical treatment approach is closely associated with an extremely low 1-year failure rate of VPS. This transitional strategy can significantly reduce the high failure rate following VPS.