Clinical Characteristics, Outcomes, Revision Rates, and Economic Impact of Ventricular Shunt Surgery in Pediatric Patients

Clinical Characteristics, Outcomes, Revision Rates, and Economic Impact of Ventricular Shunt Surgery in Pediatric Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Characteristics, Outcomes, Revision Rates, and Economic Impact of Ventricular Shunt Surgery in Pediatric Patients Ures Eduardo Campos-Rodríguez, Julio César López-Valdés, Mallyolo Eliezer Pelayo-Salazar, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7735779/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To describe the clinical features, treatment modalities, and frequency of surgical revisions in pediatric patients who underwent ventricular shunt procedures. Methods A retrospective, descriptive, observational study was conducted at the Hospital de Pediatría "Dr. Silvestre Frenk Freund," National Medical Center "Siglo XXI." Medical records of 371 patients aged 0–16 years who underwent ventricular cerebrospinal fluid diversion surgeries between January 2013 and May 2021 were analyzed. Demographic data, etiology, surgical modality, and revision frequency were collected and analyzed using descriptive statistics. Results Among the 371 patients, 59% were male and 41% were female. The primary etiologies were congenital malformations (37%), neoplasms (24%), hemorrhage (14%), infections (10%), trauma (5%), cysts (5%), and idiopathic causes (4%). Of the cohort, 59.8% required only one surgery, while 40.2% underwent multiple surgical interventions, with a maximum of 22 surgeries in one patient. Initial treatment predominantly involved external ventricular drainage (50.2%), followed by ventriculoperitoneal shunt placement (41.0%). Notably, 38% of patients with initial ventriculoperitoneal shunt placement required at least one revision surgery. Conclusion Ventricular shunt surgery remains a critical intervention in pediatric neurosurgery, often requiring multidisciplinary management. Despite advancements, a significant proportion of patients require multiple interventions, highlighting the need for improved surgical techniques and postoperative care strategies. This study provides a foundation for future prospective studies aimed at reducing revision rates and improving outcomes. Hydrocephalus Ventricular Shunt Pediatric Neurosurgery Revision Surgery Cerebrospinal Fluid Diversion Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Hydrocephalus is an ancient disease whose management has evolved dramatically with advances in neurosurgery and biomedical engineering. 1 , 2 Initially a uniformly fatal condition, the development of implantable CSF (cerebrospinal fluid) shunt systems in the 20th century transformed hydrocephalus into a manageable entity, particularly in pediatric populations. 3 – 6 Despite technological progress, hydrocephalus remains complex, with diverse etiologies and a persistent risk of shunt failure requiring revision surgeries. 7 – 9 In addition to the clinical challenges, the management of hydrocephalus imposes a considerable financial burden on healthcare systems and families. Lim, et a 10 estimated that the total average cost of a VP (ventriculoperitoneal) shunt surgery in pediatric patients, including hospitalization and follow-up for 12 months, is approximately $ 130,839 USD. Meanwhile Lam et al 11 found that the average cost of hospitalization for the initial placement of a VP shunt is $ 49,317 USD, with an average hospital stay of 18.2 days. The costs of VP shunt surgery in Mexico are significantly lower than in the United States, which can represent an economic advantage for patients. 12 However, it is important to consider that costs may vary depending on the complexity of the case, the need for revision surgeries, and the length of hospitalization. This study aimed to describe the clinical characteristics, treatment modalities, and revision frequencies in a large cohort of pediatric patients undergoing ventricular shunt procedures at a high-volume tertiary care center in Mexico. Additionally, a basic cost analysis of a ventriculoperitoneal shunt surgery was performed MATERIALS AND METHODS A retrospective observational study was conducted at the Hospital de Pediatría "Dr. Silvestre Frenk Freund," National Medical Center " Siglo XXI." Inclusion criteria were patients aged 0–16 years diagnosed with hydrocephalus or related pathologies requiring CSF diversion procedures from January 2013 to May 2021. Patients treated initially at other institutions or without complete follow-up were excluded. Data collected included age, sex, primary diagnosis, surgical modality, and number of surgical revisions. Statistical analysis was performed using SPSS version 21, applying descriptive statistics for categorical and continuous variables. The economic impact was estimated average cost of $ 6,000 USD per surgical procedure — including hospitalization, surgical materials, and postoperative care according to the “ Catalog of Interventions, Treatments, Auxiliary Diagnostic Services and Rates for the Exchange of Services 2022 pubished” by the Mexican Government. 12 The study protocol was approved by the Institutional Review Board and the Ethics committee of Hospital de Pediatría "Dr. Silvestre Frenk Freund," National Medical Center "Siglo XXI." I.M.S.S, under the number project R-2021-3603-061 RESULTS A descriptive, retrospective, observational, and cross-sectional study was conducted, including a total of 371 pediatric patients who underwent ventricular cerebrospinal fluid (CSF) diversion procedures. Of 371 patients included, 220 (59%) were male and 151 (41%) were female. The age distribution is shown in Table 1 Table 1 Patients distribution according age group Age Group n (%) 0–28 days (Neonates) 101 (27.2%) 29 days–24 months (Infants) 79 (21.3%) 24 months and 1 day–6 years 68 (18.3%) 6 years 1 day–12 years 72 (19.4%) 12 years 1 day–16 years 51 (13.8%) Total 371 (100%) Primary etiologies were congenital malformations (37%), neoplasms (24%), hemorrhage (14%), infections (10%), trauma (5%), cysts (5%), and idiopathic causes (4%). A total of 729 surgical procedures were recorded among the 371 patients; initial surgical interventions included: external ventricular drainage (50.2%), ventriculoperitoneal shunt placement (41.0%), endoscopic procedures (4.1%), cystoperitoneal shunt placement (1.8%) and other procedures (< 2%). The rest of the results are shown in table Fig. 1 Regarding outcomes, 222 patients (59.8%) required only one surgical intervention. The remaining 149 patients (40.2%) underwent multiple interventions. Among these, the number of surgeries ranged from 2 to 22, with a median of two revisions. Figure 2 Among the 257 patients initially treated with a ventriculoperitoneal shunt: 159 patients (62%) had successful outcomes without the need for revision and 98 patients (38%) required at least one revision surgery. Economic Impact Estimation Using an estimated average cost of $ 6,000 USD per surgical procedure — including hospitalization, surgical materials, and postoperative care — the total healthcare expenditure for the cohort was approximately: 729 × 6000 = 4,374,000 USD. (Table 2 & Fig. 3 ) Table 2 Summary of Estimated Surgical Costs Concept Value Total number of patients 371 Estimated average cost per surgery $ 6,000 USD Estimated total cost (entire cohort) $ 4, 374,000 USD Estimated average cost per patient $ 11,789 USD DISCUSSION This study reflects the persistent challenges associated with the surgical management of hydrocephalus and related conditions in pediatric patients. Although a majority achieved satisfactory outcomes with a single intervention, a substantial proportion required multiple surgeries, consistent with international literature. In studies from Anglo-Saxon countries, such as the United States and the United Kingdom, the rate of shunt revision ranges between 30% and 50% within the first two years post-implantation. 13 – 15 Our observed revision rate (40.2%) is within this range, suggesting that, despite institutional and regional differences, shunt failure remains a universal challenge in pediatric hydrocephalus care. The distribution of etiologies in our cohort also differed from that reported in high-income countries. While congenital malformations were the leading cause of hydrocephalus in our study (37%), other studies have reported a predominance of post-hemorrhagic hydrocephalus secondary to prematurity, likely reflecting differences in neonatal intensive care outcomes. 16 – 20 The high frequency of initial external ventricular drainage (EVD) procedures observed in our population (50.2%) suggests a pattern of cautious management in unstable or complex cases before definitive shunting. This practice contrasts with centers that favor early definitive shunt placement to minimize infection risk, highlighting variations in institutional protocols. 21 – 23 Several factors may contribute to the revision rates observed, including patient comorbidities, infection rates, valve malfunction, and resource variability. 22 – 25 Recent advances such as antibiotic-impregnated catheters and programmable valves have demonstrated potential to reduce revision rates, yet access to such technologies remains limited in many middle-income countries. 24 , 25 The economic impact is also considerable. Our analysis estimated an average cost of approximately $ 11,789 USD per patient, rising significantly for patients undergoing multiple revisions. This financial burden, combined with increased morbidity and prolonged hospitalizations, underscores the need for multidisciplinary strategies aimed at reducing shunt failure rates. Overall, our findings align with international trends while reflecting regional epidemiological and resource-specific realities. Continuous monitoring of outcomes, adherence to best surgical practices, and access to advanced technologies will be critical to improving long-term prognoses in pediatric hydrocephalus. Strengths and Limitations Strengths One of the main strengths of this study is the relatively large sample size, comprising 371 pediatric patients treated over an eight-year period at a major national referral center. This enhances the generalizability of the findings within similar healthcare contexts. Additionally, the inclusion of detailed surgical and revision data allows for a comprehensive analysis of treatment modalities, outcomes, and economic implications. The study also highlights local epidemiological characteristics that are underrepresented in international literature, providing valuable insights for future regional healthcare planning. Limitations As a retrospective observational study, this analysis is inherently subject to selection and information biases. Data were obtained from clinical records, which may have inconsistencies or missing information not accounted for during the review. Moreover, the study was conducted at a single center, limiting the ability to generalize findings to other institutions with different patient populations or healthcare resources. Another limitation is the lack of detailed stratification by hydrocephalus severity, shunt type, and valve characteristics, which could influence revision rates. Finally, while an economic estimate was provided, it did not capture indirect costs such as outpatient visits, rehabilitation needs, or caregiver burden, potentially underestimating the true societal cost of hydrocephalus management. Future prospective, multicenter studies are needed to validate these findings and to further explore interventions that could reduce surgical revisions and optimize cost-effectiveness. CONCLUSION Hydrocephalus management in pediatric populations continues to present significant challenges, particularly regarding surgical revision rates. This study underscores the importance of comprehensive perioperative care, vigilant postoperative monitoring, and ongoing research to identify modifiable risk factors for shunt failure. Future prospective studies are warranted to develop strategies that can reduce the burden of surgical revisions and improve patient quality of life Ventricular cerebrospinal fluid diversion remains a cornerstone of pediatric neurosurgical practice, yet it continues to present significant challenges. In this retrospective analysis, we observed that while a majority of patients achieved favorable outcomes with a single procedure, a substantial proportion (40.2%) required multiple surgical interventions. This finding aligns with international data and underscores the persistent burden of shunt failure in pediatric populations. The predominance of congenital malformations as the underlying etiology in our cohort highlights regional epidemiological differences compared to other reports, where post-hemorrhagic hydrocephalus is more prevalent. These differences should be considered when designing preventive strategies and early management protocols tailored to specific healthcare settings. Our findings also reveal that the economic impact of shunt surgeries and revisions is considerable, with an estimated average cost per patient exceeding $ 11,000 USD, and significantly higher in those requiring multiple interventions. In this context, efforts to reduce revision rates are not only medically necessary but also economically imperative, particularly in middle-income countries where healthcare resources are limited. To improve long-term outcomes, a multidisciplinary approach involving neurosurgeons, infectious disease specialists, rehabilitation teams, and caregivers is essential. Furthermore, access to advanced technologies such as antibiotic-impregnated shunt systems, programmable valves, and enhanced perioperative protocols could play a critical role in minimizing complications and optimizing surgical success. Future prospective studies are warranted to identify modifiable risk factors for shunt failure, evaluate the effectiveness of new technologies, and develop regionally appropriate clinical guidelines. A stronger emphasis on individualized patient care and preventive strategies could ultimately reduce the physical, emotional, and financial burden of hydrocephalus management in pediatric populations. In conclusion, while significant advances have been made, pediatric hydrocephalus management remains a complex and evolving field. Continuous monitoring, innovation, and investment in healthcare infrastructure are vital to ensuring better outcomes for affected children worldwide. Declarations Conflicts of interest/Competing interests The authors declare they have no conflicts of interest. The principal investigators and research team members have no financial or personal relationships that could inappropriately influence or bias the research presented. This includes no affiliations with organizations that have a direct or indirect financial interest in the subject matter, such as pharmaceutical companies, medical device manufacturers, or other commercial entities. Furthermore, there are no competing intellectual interests or non-financial conflicts that could compromise the integrity of the work. Ethics approval The study protocol was approved by the Institutional Review Board and the Ethics committee of Hospital de Pediatría "Dr. Silvestre Frenk Freund," National Medical Center "Siglo XXI." I.M.S.S, under project number R-2021-3603-061. Consent to participate Not applicable. Written Consent for publication Not applicable. Funding This report did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution UECR, MEPS, and JCLV contributed to the conceptualization, writing of the initial draft, and creation of the database. UECR, DAVM, and JCLV were responsible for data collection, statistical analysis, editing, translation, and supervision. DMB, EFHG, and ZESR collected data and provided a second round of editing. LMO and JCLV provided supervision and final editing. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7735779","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":532577903,"identity":"16114847-e520-4935-9046-d0197c688021","order_by":0,"name":"Ures Eduardo Campos-Rodríguez","email":"","orcid":"","institution":"National Medical Center \"Siglo XXI.\" I.M.S.S. 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19:41:11","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":14648,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig1hidrocfa.png","url":"https://assets-eu.researchsquare.com/files/rs-7735779/v1/747d78b6da224d6335ab93fb.png"},{"id":94140831,"identity":"c7cd16ae-3a3a-4ece-ae5b-287e3ee1c4b2","added_by":"auto","created_at":"2025-10-22 19:49:10","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":14297,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefig2hidrocefalo.png","url":"https://assets-eu.researchsquare.com/files/rs-7735779/v1/724695d6afed7fd0f64a97c1.png"},{"id":94140470,"identity":"e3a5e2d5-5a9d-4b24-b682-40c1f6a61376","added_by":"auto","created_at":"2025-10-22 19:41:10","extension":"xml","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":65169,"visible":true,"origin":"","legend":"","description":"","filename":"651363cce2e040b38fd803c02f4dbd881structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7735779/v1/ec1ab885bf4b72c7acd27233.xml"},{"id":94139367,"identity":"80b13a01-d5f1-4dfb-9cee-414810b33688","added_by":"auto","created_at":"2025-10-22 19:33:10","extension":"html","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":74350,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7735779/v1/d4b6ce684a9f85b3c2bb84ec.html"},{"id":94139351,"identity":"2ddba56b-7263-46bb-b089-304c08a13d04","added_by":"auto","created_at":"2025-10-22 19:33:10","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":46798,"visible":true,"origin":"","legend":"\u003cp\u003eTypes of Surgical Procedures Performed for CSF Diversion.\u003cbr\u003e\nHorizontal bar graph showing the percentage distribution of surgical interventions: external ventricular drainage (50.2%), ventriculoperitoneal shunt placement (41.0%), endoscopic procedures (4.1%), cystoperitoneal shunt placement (1.8%), and others (\u0026lt;2%).\u003c/p\u003e","description":"","filename":"Fig1hidrocfa.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7735779/v1/2e557c7a59f9d64ef2cfae60.jpg"},{"id":94139354,"identity":"22105d3c-6e55-4cd3-8d9f-bbefaf403631","added_by":"auto","created_at":"2025-10-22 19:33:10","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":34657,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of Surgeries Required per Patient.\u003cbr\u003e\nBar graph representing the distribution of the number of surgeries per patient. While 59.8% of patients required only one surgery, 40.2% required two or more, with some undergoing up to 22 procedures.\u003c/p\u003e","description":"","filename":"fig2hidrocefalo.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7735779/v1/e03174ef9c96abde8017b7ea.jpg"},{"id":94139352,"identity":"3b04a551-e443-4629-bc0c-605d1c159035","added_by":"auto","created_at":"2025-10-22 19:33:10","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":41117,"visible":true,"origin":"","legend":"\u003cp\u003eEstimated Cost per Patient According to the Number of Surgeries.\u003cbr\u003e\nBar graph displaying the estimated cumulative cost per patient based on the number of surgical interventions, assuming an average cost of $6,000 USD per surgery. Costs ranged from $6,000 USD for a single procedure up to $132,000 USD for patients requiring 22 surgeries.\u003c/p\u003e","description":"","filename":"Fig3hidrocefalo.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7735779/v1/f6a5f85187f1eb249b7679b3.jpg"},{"id":94261591,"identity":"c78a781e-8a8c-44cd-a828-0be153ccc6b7","added_by":"auto","created_at":"2025-10-24 08:54:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":630809,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7735779/v1/049fd4f0-2863-48e1-a074-f784dd3ab931.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eClinical Characteristics, Outcomes, Revision Rates, and Economic Impact of Ventricular Shunt Surgery in Pediatric Patients \u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eHydrocephalus is an ancient disease whose management has evolved dramatically with advances in neurosurgery and biomedical engineering.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Initially a uniformly fatal condition, the development of implantable CSF (cerebrospinal fluid) shunt systems in the 20th century transformed hydrocephalus into a manageable entity, particularly in pediatric populations.\u003csup\u003e\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Despite technological progress, hydrocephalus remains complex, with diverse etiologies and a persistent risk of shunt failure requiring revision surgeries.\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn addition to the clinical challenges, the management of hydrocephalus imposes a considerable financial burden on healthcare systems and families. Lim, et a\u003csup\u003e10\u003c/sup\u003e estimated that the total average cost of a VP (ventriculoperitoneal) shunt surgery in pediatric patients, including hospitalization and follow-up for 12 months, is approximately \u003cspan\u003e$\u003c/span\u003e130,839 USD. Meanwhile Lam et al\u003csup\u003e11\u003c/sup\u003e found that the average cost of hospitalization for the initial placement of a VP shunt is \u003cspan\u003e$\u003c/span\u003e49,317 USD, with an average hospital stay of 18.2 days.\u003c/p\u003e\u003cp\u003eThe costs of VP shunt surgery in Mexico are significantly lower than in the United States, which can represent an economic advantage for patients.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e However, it is important to consider that costs may vary depending on the complexity of the case, the need for revision surgeries, and the length of hospitalization.\u003c/p\u003e\u003cp\u003eThis study aimed to describe the clinical characteristics, treatment modalities, and revision frequencies in a large cohort of pediatric patients undergoing ventricular shunt procedures at a high-volume tertiary care center in Mexico. Additionally, a basic cost analysis of a ventriculoperitoneal shunt surgery was performed\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eA retrospective observational study was conducted at the \u003cem\u003eHospital de Pediatr\u0026iacute;a \"Dr. Silvestre Frenk Freund,\"\u003c/em\u003e National Medical Center \"\u003cem\u003eSiglo XXI.\"\u003c/em\u003e Inclusion criteria were patients aged 0\u0026ndash;16 years diagnosed with hydrocephalus or related pathologies requiring CSF diversion procedures from January 2013 to May 2021. Patients treated initially at other institutions or without complete follow-up were excluded.\u003c/p\u003e\u003cp\u003eData collected included age, sex, primary diagnosis, surgical modality, and number of surgical revisions. Statistical analysis was performed using SPSS version 21, applying descriptive statistics for categorical and continuous variables.\u003c/p\u003e\u003cp\u003eThe economic impact was estimated average cost of \u003cspan\u003e$\u003c/span\u003e6,000 USD per surgical procedure \u0026mdash; including hospitalization, surgical materials, and postoperative care according to the \u0026ldquo;\u003cem\u003eCatalog of Interventions, Treatments, Auxiliary Diagnostic Services and Rates for the Exchange of Services 2022 pubished\u0026rdquo;\u003c/em\u003e by the Mexican Government.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e The study protocol was approved by the Institutional Review Board and the Ethics committee of Hospital de Pediatr\u0026iacute;a \"Dr. Silvestre Frenk Freund,\" National Medical Center \"Siglo XXI.\" I.M.S.S, under the number project R-2021-3603-061\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA descriptive, retrospective, observational, and cross-sectional study was conducted, including a total of 371 pediatric patients who underwent ventricular cerebrospinal fluid (CSF) diversion procedures. Of 371 patients included, 220 (59%) were male and 151 (41%) were female. The age distribution is shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatients distribution according age group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;28 days (Neonates)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e101 (27.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e29 days\u0026ndash;24 months (Infants)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79 (21.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24 months and 1 day\u0026ndash;6 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68 (18.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 years 1 day\u0026ndash;12 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72 (19.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12 years 1 day\u0026ndash;16 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51 (13.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e371 (100%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePrimary etiologies were congenital malformations (37%), neoplasms (24%), hemorrhage (14%), infections (10%), trauma (5%), cysts (5%), and idiopathic causes (4%). A total of 729 surgical procedures were recorded among the 371 patients; initial surgical interventions included: external ventricular drainage (50.2%), ventriculoperitoneal shunt placement (41.0%), endoscopic procedures (4.1%), cystoperitoneal shunt placement (1.8%) and other procedures (\u0026lt;\u0026thinsp;2%). The rest of the results are shown in table Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eRegarding outcomes, 222 patients (59.8%) required only one surgical intervention. The remaining 149 patients (40.2%) underwent multiple interventions. Among these, the number of surgeries ranged from 2 to 22, with a median of two revisions. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAmong the 257 patients initially treated with a ventriculoperitoneal shunt: 159 patients (62%) had successful outcomes without the need for revision and 98 patients (38%) required at least one revision surgery.\u003c/p\u003e\n\u003ch3\u003eEconomic Impact Estimation\u003c/h3\u003e\n\u003cp\u003eUsing an estimated average cost of \u003cspan\u003e$\u003c/span\u003e6,000 USD per surgical procedure \u0026mdash; including hospitalization, surgical materials, and postoperative care \u0026mdash; the total healthcare expenditure for the cohort was approximately: 729 \u0026times; 6000\u0026thinsp;=\u0026thinsp;4,374,000 USD. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u0026amp; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of Estimated Surgical Costs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConcept\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eValue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal number of patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e371\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEstimated average cost per surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e6,000 USD\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEstimated total cost (entire cohort)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e4, 374,000 USD\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEstimated average cost per patient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e11,789 USD\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study reflects the persistent challenges associated with the surgical management of hydrocephalus and related conditions in pediatric patients. Although a majority achieved satisfactory outcomes with a single intervention, a substantial proportion required multiple surgeries, consistent with international literature.\u003c/p\u003e\u003cp\u003eIn studies from Anglo-Saxon countries, such as the United States and the United Kingdom, the rate of shunt revision ranges between 30% and 50% within the first two years post-implantation.\u003csup\u003e\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Our observed revision rate (40.2%) is within this range, suggesting that, despite institutional and regional differences, shunt failure remains a universal challenge in pediatric hydrocephalus care.\u003c/p\u003e\u003cp\u003eThe distribution of etiologies in our cohort also differed from that reported in high-income countries. While congenital malformations were the leading cause of hydrocephalus in our study (37%), other studies have reported a predominance of post-hemorrhagic hydrocephalus secondary to prematurity, likely reflecting differences in neonatal intensive care outcomes.\u003csup\u003e\u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe high frequency of initial external ventricular drainage (EVD) procedures observed in our population (50.2%) suggests a pattern of cautious management in unstable or complex cases before definitive shunting. This practice contrasts with centers that favor early definitive shunt placement to minimize infection risk, highlighting variations in institutional protocols.\u003csup\u003e\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eSeveral factors may contribute to the revision rates observed, including patient comorbidities, infection rates, valve malfunction, and resource variability.\u003csup\u003e\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Recent advances such as antibiotic-impregnated catheters and programmable valves have demonstrated potential to reduce revision rates, yet access to such technologies remains limited in many middle-income countries.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe economic impact is also considerable. Our analysis estimated an average cost of approximately \u003cspan\u003e$\u003c/span\u003e11,789 USD per patient, rising significantly for patients undergoing multiple revisions. This financial burden, combined with increased morbidity and prolonged hospitalizations, underscores the need for multidisciplinary strategies aimed at reducing shunt failure rates.\u003c/p\u003e\u003cp\u003eOverall, our findings align with international trends while reflecting regional epidemiological and resource-specific realities. Continuous monitoring of outcomes, adherence to best surgical practices, and access to advanced technologies will be critical to improving long-term prognoses in pediatric hydrocephalus.\u003c/p\u003e\n\u003ch3\u003eStrengths and Limitations\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStrengths\u003c/h2\u003e\u003cp\u003e One of the main strengths of this study is the relatively large sample size, comprising 371 pediatric patients treated over an eight-year period at a major national referral center. This enhances the generalizability of the findings within similar healthcare contexts.\u003c/p\u003e\u003cp\u003eAdditionally, the inclusion of detailed surgical and revision data allows for a comprehensive analysis of treatment modalities, outcomes, and economic implications. The study also highlights local epidemiological characteristics that are underrepresented in international literature, providing valuable insights for future regional healthcare planning.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eAs a retrospective observational study, this analysis is inherently subject to selection and information biases. Data were obtained from clinical records, which may have inconsistencies or missing information not accounted for during the review.\u003c/p\u003e\u003cp\u003eMoreover, the study was conducted at a single center, limiting the ability to generalize findings to other institutions with different patient populations or healthcare resources.\u003c/p\u003e\u003cp\u003eAnother limitation is the lack of detailed stratification by hydrocephalus severity, shunt type, and valve characteristics, which could influence revision rates.\u003c/p\u003e\u003cp\u003eFinally, while an economic estimate was provided, it did not capture indirect costs such as outpatient visits, rehabilitation needs, or caregiver burden, potentially underestimating the true societal cost of hydrocephalus management.\u003c/p\u003e\u003cp\u003eFuture prospective, multicenter studies are needed to validate these findings and to further explore interventions that could reduce surgical revisions and optimize cost-effectiveness.\u003c/p\u003e\u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eHydrocephalus management in pediatric populations continues to present significant challenges, particularly regarding surgical revision rates. This study underscores the importance of comprehensive perioperative care, vigilant postoperative monitoring, and ongoing research to identify modifiable risk factors for shunt failure. Future prospective studies are warranted to develop strategies that can reduce the burden of surgical revisions and improve patient quality of life\u003c/p\u003e\u003cp\u003eVentricular cerebrospinal fluid diversion remains a cornerstone of pediatric neurosurgical practice, yet it continues to present significant challenges. In this retrospective analysis, we observed that while a majority of patients achieved favorable outcomes with a single procedure, a substantial proportion (40.2%) required multiple surgical interventions. This finding aligns with international data and underscores the persistent burden of shunt failure in pediatric populations.\u003c/p\u003e\u003cp\u003eThe predominance of congenital malformations as the underlying etiology in our cohort highlights regional epidemiological differences compared to other reports, where post-hemorrhagic hydrocephalus is more prevalent. These differences should be considered when designing preventive strategies and early management protocols tailored to specific healthcare settings.\u003c/p\u003e\u003cp\u003eOur findings also reveal that the economic impact of shunt surgeries and revisions is considerable, with an estimated average cost per patient exceeding \u003cspan\u003e$\u003c/span\u003e11,000 USD, and significantly higher in those requiring multiple interventions. In this context, efforts to reduce revision rates are not only medically necessary but also economically imperative, particularly in middle-income countries where healthcare resources are limited.\u003c/p\u003e\u003cp\u003eTo improve long-term outcomes, a multidisciplinary approach involving neurosurgeons, infectious disease specialists, rehabilitation teams, and caregivers is essential. Furthermore, access to advanced technologies such as antibiotic-impregnated shunt systems, programmable valves, and enhanced perioperative protocols could play a critical role in minimizing complications and optimizing surgical success.\u003c/p\u003e\u003cp\u003e Future prospective studies are warranted to identify modifiable risk factors for shunt failure, evaluate the effectiveness of new technologies, and develop regionally appropriate clinical guidelines. A stronger emphasis on individualized patient care and preventive strategies could ultimately reduce the physical, emotional, and financial burden of hydrocephalus management in pediatric populations.\u003c/p\u003e\u003cp\u003eIn conclusion, while significant advances have been made, pediatric hydrocephalus management remains a complex and evolving field. Continuous monitoring, innovation, and investment in healthcare infrastructure are vital to ensuring better outcomes for affected children worldwide.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflicts of interest/Competing interests\u003c/h2\u003e\u003cp\u003eThe authors declare they have no conflicts of interest. The principal investigators and research team members have no financial or personal relationships that could inappropriately influence or bias the research presented. This includes no affiliations with organizations that have a direct or indirect financial interest in the subject matter, such as pharmaceutical companies, medical device manufacturers, or other commercial entities. Furthermore, there are no competing intellectual interests or non-financial conflicts that could compromise the integrity of the work.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003cp\u003eThe study protocol was approved by the Institutional Review Board and the Ethics committee of Hospital de Pediatr\u0026iacute;a \"Dr. Silvestre Frenk Freund,\" National Medical Center \"Siglo XXI.\" I.M.S.S, under project number R-2021-3603-061.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eWritten Consent for publication\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis report did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eUECR, MEPS, and JCLV contributed to the conceptualization, writing of the initial draft, and creation of the database. UECR, DAVM, and JCLV were responsible for data collection, statistical analysis, editing, translation, and supervision. DMB, EFHG, and ZESR collected data and provided a second round of editing. LMO and JCLV provided supervision and final editing. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript or supplementary information files\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDrake JM, Rose C. The Shunt Book. Oxford: Blackwell Science; 1995.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRaimondi AJ. A unifying theory for the definition and classification of hydrocephalus. Childs Nerv Syst. 1994;10(1):2\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRekate HL. The definition and classification of hydrocephalus: a personal recommendation to stimulate debate. 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Disponible en: chrome-\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003eextension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.gob.mx/cms/uploads/attachment/file/703882/Cat_logo_de_intervenciones_con_tarifas_2022.pdf\u003c/span\u003e\u003cspan address=\"http://extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.gob.mx/cms/uploads/attachment/file/703882/Cat_logo_de_intervenciones_con_tarifas_2022.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accedido 24 Abr. 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFern\u0026aacute;ndez-M\u0026eacute;ndez R, Richards HK, Seeley HM, Pickard JD, Joannides AJ; UKSR collaborators. Current epidemiology of cerebrospinal fluid shunt surgery in the UK and Ireland (2004\u0026ndash;2013). J Neurol Neurosurg Psychiatry. 2019;90(7):747\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUK Shunt Registry [Internet]. 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Hydrocephalus Clinical Research Network. Shunt treatment of posthemorrhagic hydrocephalus: a prospective cohort study. J Neurosurg Pediatr. 2015;16(1):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKulkarni AV, Drake JM, Lamberti-Pasculli M. Cerebrospinal fluid shunt infection: a prospective study of risk factors. J Neurosurg. 2001;94(2):195\u0026ndash;201.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmith ER, Butler WE, Barker FG 2nd. In-hospital mortality rates after ventriculoperitoneal shunt procedures in the United States, 1998 to 2000: relation to hospital and surgeon volume of care. J Neurosurg. 2004;100(2 Suppl Pediatrics):90\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu Y, Green NL, Wrensch MR, Zhao S, Gupta N. Ventriculoperitoneal shunt complications in California: 1990 to 2000. Neurosurgery. 2007;61(3):557\u0026ndash;62; discussion 562\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStein SC, Guo W. Have we made progress in preventing shunt failure? A critical analysis. J Neurosurg Pediatr. 2008;1(1):40\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eParker SL, McGirt MJ, Murphy JA, Megerian JT, Stout M, Engelhart L. Cost savings associated with antibiotic-impregnated shunt catheters in the treatment of adult and pediatric hydrocephalus. World Neurosurg. 2015;83(3):382\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hydrocephalus, Ventricular Shunt, Pediatric Neurosurgery, Revision Surgery, Cerebrospinal Fluid Diversion","lastPublishedDoi":"10.21203/rs.3.rs-7735779/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7735779/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo describe the clinical features, treatment modalities, and frequency of surgical revisions in pediatric patients who underwent ventricular shunt procedures.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective, descriptive, observational study was conducted at the \u003cem\u003eHospital de Pediatr\u0026iacute;a \"Dr. Silvestre Frenk Freund,\"\u003c/em\u003e National Medical Center \u003cem\u003e\"Siglo XXI.\"\u003c/em\u003e Medical records of 371 patients aged 0\u0026ndash;16 years who underwent ventricular cerebrospinal fluid diversion surgeries between January 2013 and May 2021 were analyzed. Demographic data, etiology, surgical modality, and revision frequency were collected and analyzed using descriptive statistics.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong the 371 patients, 59% were male and 41% were female. The primary etiologies were congenital malformations (37%), neoplasms (24%), hemorrhage (14%), infections (10%), trauma (5%), cysts (5%), and idiopathic causes (4%). Of the cohort, 59.8% required only one surgery, while 40.2% underwent multiple surgical interventions, with a maximum of 22 surgeries in one patient. Initial treatment predominantly involved external ventricular drainage (50.2%), followed by ventriculoperitoneal shunt placement (41.0%). Notably, 38% of patients with initial ventriculoperitoneal shunt placement required at least one revision surgery.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eVentricular shunt surgery remains a critical intervention in pediatric neurosurgery, often requiring multidisciplinary management. Despite advancements, a significant proportion of patients require multiple interventions, highlighting the need for improved surgical techniques and postoperative care strategies. This study provides a foundation for future prospective studies aimed at reducing revision rates and improving outcomes.\u003c/p\u003e","manuscriptTitle":"Clinical Characteristics, Outcomes, Revision Rates, and Economic Impact of Ventricular Shunt Surgery in Pediatric Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-22 19:33:05","doi":"10.21203/rs.3.rs-7735779/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1a9e60a1-7af0-4546-8afa-a40081485130","owner":[],"postedDate":"October 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-24T08:54:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-22 19:33:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7735779","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7735779","identity":"rs-7735779","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}