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.

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.