Background: Few studies in Japan have compiled and statistically analyzed data on shunt survival time and risk factors for shunt failure in ventriculoperitoneal shunts (VPS) for pediatric hydrocephalus.

Methods: We statistically analyzed the long-term results of VPS placement at our institution and the factors that led to shunt failure. Data were retrospectively collected from patients aged 18 years or younger with a VPS installed at our facility between January 2012 and December 2022. The period until reconstruction in all cases was analyzed using the Kaplan-Meier method. In addition, univariate analysis was performed using Log Rank (Mantel-Cox) test, and multivariate analysis was performed using the Cox regression proportional hazards model.

Results: A total of 167 patients were included, and 19 patients who died or discontinued follow-up were censored. The 1-year and 2-year survival rates (95% confidence interval) were 82.3% (76.2-88.4%) and 78.4% (71.7-85.1%), respectively. Univariate and multivariate analysis showed that no significant risk factors for shunt failure. On the other hand, the age at the time of shunt failure was 1.83 years for anterior horn puncture group and 5.19 years for posterior horn puncture group (P = 0.022).

Conclusion: This analysis did not reveal any significant risk factors for shunt failure. However, the age at the time of shunt failure after posterior horn puncture was significantly higher. We therefore believe that it is necessary to devise ways to reduce the effect of increased height, such as by creating a curve.

In this report, we describe a case of cerebrospinal fluid (CSF) otorrhea following acute epidural hematoma surgery performed at the age of 13 due to a traumatic head injury (THI) from a traffic accident. During the two-year postoperative follow-up, the patient experienced persistent hearing loss and CSF leakage from the middle ear. Therefore, at age 15, open repair of the CSF otorrhea was performed on the same day as tympanoplasty by an otolaryngologist. This case involved: 1) identifying the fracture site using preoperative 3D imaging, 2) localizing the CSF leak with fluorescein, 3) covering the dural side with a nonwoven fabric composed of polyglycolic acid (PGA) and fibrin glue, and 4) covering the fracture site with a pedicled temporalis fascia flap. Postoperative follow-up showed a reduction in CSF leakage and improvement in hearing. Long-term follow-up and collaboration with otolaryngologists are crucial for improving the quality of life (QOL) in pediatric patients with head trauma and associated hearing loss. In conclusion, this report emphasizes the importance of long-term follow-up after pediatric THI and collaboration with related clinical departments, supplemented by a review of the relevant literature.