Ventriculo-Abdominal Subcutaneous Tunnelled External Drainage as a Transition Therapy to Reduce Shunt Failure Rate in Post-infection Hydrocephalus Patients: A single-center retrospective cohort study

OBJECTIVE: Assess the clinical efficacy of Ventriculo-Abdominal Subcutaneous Tunnelled External Drainage (VASTED) as a transition treatment before ventriculoperitoneal shunting(VPS) in the management of post-infection hydrocephalus(PIH). METHODS: This study enrolled 384 patients who developed PIH after craniotomy. Following external ventricular drainage(EVD) and combined intravenous antibiotic therapy, patients underwent VASTED as a transitional treatment measure before definitive VPS placement when they achieved three consecutive negative cerebrospinal fluid(CSF) bacterial cultures within two weeks and no pathogen detection by metagenomic next-generation sequencing (mNGS). The primary endpoint of the study was the shunt failure rate after one year of follow-up, with infection and catheter blockage as the evaluation criteria. RESULTS: A total of 378 cases underwent VPS surgery, with 6 cases refusing or abandoning treatment. During a one-year follow-up period, 9 shunt failures occurred (2.38%, 95% CI: 0.43-3.05). Among these, 5 failures were infection-related (1.3%) and 4 were due to pure mechanical obstruction (1.1%). The shortest duration of VASTED was 14 days, while the longest was 387 days, with a median drainage time of 69 days (95% CI: 28-112 days). CONCLUSION: In patients with PIH, implementing VASTED as a transitional surgical treatment approach is closely associated with an extremely low one-year failure rate of VPS. This transitional strategy can significantly reduce the high failure rate following VPS.