Correlation between ventricular catheter position and shunt revision in ventriculoperitoneal shunt: a longitudinal study

Objective To establish a five-level grading system for assessing ventricular catheter positioning accuracy and investigate the longitudinal changes in catheter placement grades and their correlation with shunt revisions in hydrocephalus patients undergoing ventriculoperitoneal shunt placement. Methods A single-center retrospective study was conducted on 240 patients who underwent VPS insertion between April 31, 2010 to May 1, 2020. A novel five-level grading system was developed based on the contact relationship between the catheter tip/perforated segment and the ventricular wall/choroid plexus. Grade 1, both the tip and perforated segment completely free-floating in the frontal horn; Grade 2, tip contacting/penetrating the ventricular wall with a free-floating perforated segment; Grade 3, perforated segment contacting the ventricular wall or choroid plexus; Grade 4, <50% of the perforated segment penetrating the ventricular wall; and Grade 5, ≥50% of the perforated segment penetrating the ventricular wall. Catheter positioning was evaluated on post-operative imaging and at 1-year follow-up. Multivariate logistic regression analysis was performed to identify independent predictors of 5-year shunt revision. Results Among 197 patients with complete 5-year follow-up data, 51 patients (25.9%) required shunt revision. Significant longitudinal changes in catheter positioning were observed from perioperative to 1-year assessment. Multivariate analysis identified four independent predictors of shunt revision: history of intracranial infection (adjusted OR = 1.247, P = 0.017), history of intraventricular operation (adjusted OR = 1.153, P < 0.001), perioperative intracranial infection (adjusted OR = 1.446, P = 0.002), and one-year postoperative catheter position grading (Grade 4: adjusted OR = 1.706, P < 0.001; Grade 5: adjusted OR = 1.803, P < 0.001. Grade 1 as reference). Conclusions The five-level grading system provides a more comprehensive assessment of ventricular catheter positioning. One-year postoperative catheter position grade is a stronger independent predictor of 5-year shunt revision than initial placement.