Anterior versus Posterior Ventricular Catheter Placement in Pediatric Patients: A Systematic Review and Meta-Analysis

Anant Naik, Natalie Ramsy, David T. Krist, Birra R Taha, Rajiv Dharnipragada, Rukhsaar Khanam, Carolina Sandoval-Garcia, Wael Hassaneen, Elizabeth C. Tyler-Kabara, Paul M. Arnold

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Ventriculoperitoneal shunt placement is the mainstay of treatment for hydrocephalus, but there are relatively high rates of malfunction. Shunt catheter entry can be performed anteriorly or posteriorly, with the body of evidence from randomized controlled trials and retrospective studies suggesting conflicting findings.

METHODS: A systematic review of PubMed, Medline, Scopus, and Web of Science was performed adherent to PRISMA guidelines, searching for clinical studies examining outcomes for anterior or frontal and posterior or occipital ventriculoperitoneal shunt placement. A random-effects model meta-analysis was performed on R.

RESULTS: Six studies (2 randomized controlled trials and 4 retrospective cohort studies) comprising 1808 patients were identified. There were no statistically significant differences between anterior and posterior ventriculoperitoneal shunt placement for the outcomes of poor catheter placement (odds ratio [OR], 0.74; P = 0.6) and shunt infections (OR, 1.01; P = 0.9). Posterior shunts trended toward greater number of shunt revisions (OR, 0.72; P = 0.06). Six and 12 months shunt survival was comparable between anterior and posterior approaches (P > 0.05). There were significant differences between long-term shunt survival (2 and 5 years shunt survival), favoring anterior shunt placement with greater odds of survival (OR, 1.91 and OR, 1.62, respectively; P < 0.05).

CONCLUSIONS: We show that although anteriorly and posteriorly placed shunts have mostly comparable outcomes, shunt survival at 2-year and 5-year intervals favors anteriorly placed shunts. Additional well-designed clinical trials are needed to validate the findings of greater late shunt failure in posteriorly placed shunts, with more time-dependent statistical measures.

Original languageEnglish (US)
Pages (from-to)e10-e18
JournalWorld neurosurgery
Volume167
DOIs
StatePublished - Nov 2022

Bibliographical note

Funding Information:
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher Copyright:
© 2022 Elsevier Inc.

Keywords

  • Drainage
  • Hydrocephalus
  • Pediatric neurosurgery
  • Shunt failure
  • Shunt survival
  • Ventriculoperitoneal shunt

PubMed: MeSH publication types

  • Journal Article

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