Cerebrospinal Fluid Shunt Failure in Children Is Associated with Medical Complexity and Shunt Position, Not Shunt Technology: A Multicenter Prospective Study from the Hydrocephalus Clinical Research Network.

OBJECTIVES: To investigate patterns of cerebrospinal fluid (CSF) shunt failure and to determine whether new risk factors have arisen as care has evolved. STUDY DESIGN: This prospective study examined first-time shunt insertions in children <18 years at 14 Hydrocephalus Clinical Research Network centers. The primary outcome was shunt failure (ie, shunt revision, subsequent endoscopic third ventriculostomy, shunt infection). Univariable and multivariable Cox proportional hazard modeling identified unadjusted and adjusted associations with shunt failure. RESULTS: Among 3686 children who underwent initial CSF shunt placement in 2018-2024, 1303 (35%) experienced shunt failure, including 1079 malfunctions (29%) and 184 infections (5%). Age 0-6 months, etiology of tumor or posthemorrhagic hydrocephalus of prematurity, gastrostomy tube, ≥2 complex chronic conditions, and posterior entry site were independently associated with shunt failure, whereas targeting adjuncts, antibiotic shunt tubing, and valve type were not. CONCLUSIONS: This contemporary re-examination of hydrocephalus shunt failure found a consistent, unchanged shunt failure rate but a decrease in shunt infection rate. New risk factors (having ≥2 complex chronic conditions, posterior entry site, hydrocephalus etiology of posthemorrhagic hydrocephalus of prematurity, or tumor) were identified.