E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Shunt Revision and Surgical Burden in Pediatric Complex Hydrocephalus: A Five-Year Single-Center Cohort Study
Duygu Dolen Burak ,
Cafer Ikbal Gulsever✉ ,
Duran Şahin ,
Mustafa Selim Sahin ,
Tugrul Cem Unal ,
Pulat Akın Sabancı ,
aydin aydoseli ,
yavuz aras ,
Altay Sencer
Neurosurgery, İstanbul Tıp Fakültesi İstanbul Üniversitesi; Neurosurgery, Istanbul University; Neurosurgery, Hakkari State Hospital; Depart. of Neurosurgery, I.U. Istanbul Medical School
Accepted: 30/08/2026
Article in Press
Corresponding Author:
Cafer Ikbal Gulsever (cafer.gulsever@gmail.com)
Abstract
Aim
Complex hydrocephalus is a high-risk form of pediatric hydrocephalus characterized by multicystic ventricular compartmentalization, previous infection, or repeated surgical interventions. This study evaluated surgical burden and factors associated with shunt revision in children with complex hydrocephalus.
Material and Methods
This retrospective cohort study included pediatric patients treated between January 2020 and January 2025. Demographic, clinical, radiological, laboratory, and operative data were reviewed. High compartment burden was defined as ≥3 intracranial ventricular compartments and elevated cerebrospinal fluid (CSF) protein as >100 mg/dL. Shunt revision was the primary outcome. Fisher's exact test and the Mann–Whitney U test were used for statistical analysis.
Results
Eleven patients were included, and shunt revision occurred in eight (72.7%). The median number of neurosurgical procedures per patient was 9 (range, 4–14). All patients with a high cyst burden required revision (6/6) compared with two of five patients with a lower cyst burden (p=0.182). CSF culture positivity was observed in four patients, all of whom underwent revision (p=0.455). Infection showed the largest effect size for revision (OR=6.11, 95% CI=0.23–162.74). Revision burden did not differ significantly between the predefined risk groups.
Conclusion
Shunt revision is common in pediatric complex hydrocephalus and is associated with substantial surgical burden. Although no factor reached statistical significance, high cyst burden and infection showed clinically meaningful associations with revision. Larger multicenter studies are needed to validate these findings.
Complex hydrocephalus is a high-risk form of pediatric hydrocephalus characterized by multicystic ventricular compartmentalization, previous infection, or repeated surgical interventions. This study evaluated surgical burden and factors associated with shunt revision in children with complex hydrocephalus.
Material and Methods
This retrospective cohort study included pediatric patients treated between January 2020 and January 2025. Demographic, clinical, radiological, laboratory, and operative data were reviewed. High compartment burden was defined as ≥3 intracranial ventricular compartments and elevated cerebrospinal fluid (CSF) protein as >100 mg/dL. Shunt revision was the primary outcome. Fisher's exact test and the Mann–Whitney U test were used for statistical analysis.
Results
Eleven patients were included, and shunt revision occurred in eight (72.7%). The median number of neurosurgical procedures per patient was 9 (range, 4–14). All patients with a high cyst burden required revision (6/6) compared with two of five patients with a lower cyst burden (p=0.182). CSF culture positivity was observed in four patients, all of whom underwent revision (p=0.455). Infection showed the largest effect size for revision (OR=6.11, 95% CI=0.23–162.74). Revision burden did not differ significantly between the predefined risk groups.
Conclusion
Shunt revision is common in pediatric complex hydrocephalus and is associated with substantial surgical burden. Although no factor reached statistical significance, high cyst burden and infection showed clinically meaningful associations with revision. Larger multicenter studies are needed to validate these findings.
Keywords
Complex hydrocephalus
Pediatric hydrocephalus
Shunt revision
Multiloculated hydrocephalus
Ventriculoperitoneal shunt