Journal of neurosurgery · 2026
Predictors of ventricular shunt survival in neoplastic hydrocephalus: a retrospective cohort study of 239 patients.
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Grin Eric A, Kelleher Andrew C, de Souza Daniel N, Palla Adhith, Gajic Zoran Z, Eremiev Alexander N, Dastagirzada Yosef M, Wisoff Jeffrey H, Hidalgo Eveline Teresa, Harter David H
Аннотация
OBJECTIVE: Hydrocephalus secondary to CNS tumors is common and carries high shunt failure rates, yet predictors of shunt survival remain poorly defined. The aim of this study was to identify patient-, tumor-, and treatment-related predictors of shunt outcomes in neoplastic hydrocephalus.
METHODS: This retrospective single-institution analysis included consecutive patients who underwent ventriculoperitoneal or ventriculoatrial shunt placement for neoplastic hydrocephalus between February 2013 and February 2024. Patients were identified using validated natural language processing and manual review. Demographic, oncological, and surgical variables, including tumor location, neurological symptoms, and resection history, were analyzed. The primary outcome was shunt revision for any cause at 1, 3, and 5 years. Fisher's exact test or the chi-square test was used for categorical comparisons. Kaplan-Meier and log-rank analyses were used to assess shunt survival, with subgroup analysis for age and etiology.
RESULTS: Overall, 239 patients (140 female, median age 53 years) were included, with 186 adults and 53 pediatric patients. Intraventricular tumor location showed the strongest association with shunt failure across all time points (5-year OR 4.39, p < 0.001). Preoperative neurological symptoms (seizures and visual/auditory deficits) were associated with higher odds of single and multiple shunt revisions (OR range 1.92-2.15, p ≤ 0.03). WHO grade 2 tumors trended toward greater late (5-year) failure risk (OR 2.8, p = 0.06). Obstruction accounted for 35.6% of shunt failures, followed by infection. Adjuvant chemotherapy and radiation therapy were not associated with shunt failure after adjustment for survival differences.
CONCLUSIONS: In this largest-to-date cohort of patients who underwent shunt placement for neoplastic hydrocephalus, the factors associated with shunt failure were intraventricular tumor location, multiple resections, and preoperative neurological symptoms. Adjuvant therapies had minimal impact. These findings support individualized risk stratification and targeted follow-up and provide a foundation for targeted prospective studies.
METHODS: This retrospective single-institution analysis included consecutive patients who underwent ventriculoperitoneal or ventriculoatrial shunt placement for neoplastic hydrocephalus between February 2013 and February 2024. Patients were identified using validated natural language processing and manual review. Demographic, oncological, and surgical variables, including tumor location, neurological symptoms, and resection history, were analyzed. The primary outcome was shunt revision for any cause at 1, 3, and 5 years. Fisher's exact test or the chi-square test was used for categorical comparisons. Kaplan-Meier and log-rank analyses were used to assess shunt survival, with subgroup analysis for age and etiology.
RESULTS: Overall, 239 patients (140 female, median age 53 years) were included, with 186 adults and 53 pediatric patients. Intraventricular tumor location showed the strongest association with shunt failure across all time points (5-year OR 4.39, p < 0.001). Preoperative neurological symptoms (seizures and visual/auditory deficits) were associated with higher odds of single and multiple shunt revisions (OR range 1.92-2.15, p ≤ 0.03). WHO grade 2 tumors trended toward greater late (5-year) failure risk (OR 2.8, p = 0.06). Obstruction accounted for 35.6% of shunt failures, followed by infection. Adjuvant chemotherapy and radiation therapy were not associated with shunt failure after adjustment for survival differences.
CONCLUSIONS: In this largest-to-date cohort of patients who underwent shunt placement for neoplastic hydrocephalus, the factors associated with shunt failure were intraventricular tumor location, multiple resections, and preoperative neurological symptoms. Adjuvant therapies had minimal impact. These findings support individualized risk stratification and targeted follow-up and provide a foundation for targeted prospective studies.