J Neurosurg Pediatr. 2026 May 29:1-7. doi: 10.3171/2026.1.PEDS25230. Online ahead of print.
ABSTRACT
OBJECTIVE: In shunted pediatric hydrocephalus patients, the potential for shunt failure is a frequent cause of emergency department (ED) presentation. The assessment of papilledema through ophthalmological fundoscopic examination (OFE) is an often-utilized adjunct evaluation in clinical workup to rule out shunt failure in patients. However, its utility in this setting has not been established in the literature. The objective of the present study was to investigate the association of papilledema with eventual shunt revision in ED encounters to rule out shunt failure.
METHODS: The authors conducted a retrospective, single-institution, cohort study of ED encounters with concern for shunt failure prompting neurosurgical evaluation in patients who underwent OFE from January 1, 2014, to December 31, 2021. Chart encounters were reviewed for baseline demographic characteristics, clinical characteristics, presence of papilledema, and interventions. The primary endpoint was need for shunt revision and intraoperative evidence of shunt failure.
RESULTS: A total of 594 ED encounters with concern for shunt failure were identified, and 98 encounters were included. Overall, 6 cases of papilledema were identified (6.1%), of whom only 3 were new or worsened (3.1%) compared to prior examinations. Twenty-six (26.5%) encounters resulted in shunt revision, while 72 (73.4%) encounters resulted in no revision. There was no statistically significant difference in baseline patient demographic characteristics, etiology of hydrocephalus, or clinical symptoms between encounters resulting in shunt revision or no revision. No significant difference was identified in the comparison of patients who underwent shunt revision versus those without revision with regard to the presence of papilledema (3 [12%] patients with papilledema vs 3 [4%] without, p = 0.19), performance of shunt tap (6 [23%] vs 9 [12.5%], p = 0.21), or prior shunt revisions (3.2 ± 3.9 vs 2.9 ± 3.3, p = 0.77).
CONCLUSIONS: Among pediatric ED encounters with concern for shunt failure, ophthalmological consultation for fundoscopic examination and the presence of papilledema did not demonstrate a significant association with shunt revision. Additional prospective studies are warranted to assess the clinical utility of using OFE as part of the armamentarium of triage in acute shunt failure evaluation.
PMID:42214105 | DOI:10.3171/2026.1.PEDS25230
