• George N Rymarczuk, Robert F Keating, Daniel J Coughlin, Daniel Felbaum, John S Myseros, Chima Oluigbo, Bhupender Yadav, Karun Sharma, and Suresh N Magge.
• Division of Neurosurgery, Children's National Health System, Washington, District of Columbia.
• Neurosurgery. 2020 Jul 1; 87 (1): 80-85.

BackgroundAlthough ventriculoperitoneal shunts (VPS) remain the first-line option in most instances of pediatric hydrocephalus, the long-term efficacy of ventriculoatrial shunts (VAS) remains unknown.ObjectiveTo characterize the long-term outcomes and adverse occurrences associated with both VPS and VAS at our institution.MethodsThe authors retrospectively analyzed all cerebrospinal fluid (CSF) shunting procedures performed over a 13-yr period at a single institution. A total of 544 pediatric shunt patients were followed for at least 90 d (VPS: 5.9 yr; VAS: 5.3 yr).ResultsA total of 54% of VPS and 60% of VAS required at least 1 revision. VPS demonstrated superior survival overall; however, if electively scheduled VAS lengthening procedures are not considered true "failures," no statistical difference is noted in overall survival (P = .08). VPS demonstrated significantly greater survival in patients less than 7 yr of age (P = .001), but showed no difference in older children (P = .4). VAS had a significantly lower rate of infection (P < .05) and proximal failure (P < .001).ConclusionVAS can be a useful alternative to VPS when the abdomen is unsuitable, particularly in older children. Although VPS demonstrates superior overall survival, it should be understood that elective VAS lengthening procedures are often necessary, especially in younger patients. If elective lengthening procedures are not considered true failures, then the devices show similar survival.Copyright © 2019 by the Congress of Neurological Surgeons.

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