Complex shunt system comparison: an observational study by the Hydrocephalus Clinical Research Network

Abstract

Objective: Treatment of multiloculated hydrocephalus can require multiple procedures and shunt catheters. This study aimed to determine whether there are differences in shunt survival or complications in patients with complex shunt systems based on whether they have separate systems or multiple intracranial catheters with a single distal catheter and a Y- or T-connector. Methods: The authors retrospectively reviewed the Hydrocephalus Clinical Research Network (HCRN) Core Data Project, a prospective multicenter registry. Patients undergoing first-time placement of a complex ventriculoperitoneal shunt or first-time conversion to a complex shunt were identified and included in the analysis. Propensity-weighted Cox regression was used to control for HCRN center and etiology using the rate of shunt failure (shunt malfunction or shunt infection) as the primary outcome. The final regression model was also adjusted for age and complex chronic conditions. Results: In total, 369 patients were included. One hundred fifty-one patients had separate systems and 218 had Y/T-connectors. After adjustment for age and comorbidities, the rate of shunt failure for systems with Y/T-connectors was not significantly different than that for separate shunt systems: 62% versus 55% (HR 1.20, 95% CI 0.91-1.59, p = 0.197). There was a statistically significant difference in operative time with separate systems having shorter operative times (mean time 63.0 vs 80.0 minutes; mean difference 16.32, 95% CI 7.53-25.10, p < 0.001). Conclusions: There were no differences in the shunt failure rates or complications between the separate shunt systems and Y/T-connector systems used to treat complex shunts. However, surgical time was significantly shorter with separate shunt systems. These findings suggest that surgeons can tailor the shunt system on the basis of individual patient characteristics.