An analysis of short-term outcomes and healthcare resource utilization for ventriculoperitoneal shunt versus endoscopic third ventriculostomy in pediatric patients with hydrocephalus following posterior fossa brain tumor resection

To compare short-term outcomes and healthcare resource utilization between ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) in pediatric patients with hydrocephalus following posterior fossa brain tumor (PFBT) resection.

Using the 2016–2020 National Inpatient Sample (NIS), we identified patients under 21 years of age who underwent PFBT resection followed by cerebrospinal fluid (CSF) diversion via VPS or ETV. Demographics, complications, discharge disposition, length of stay (LOS), and total hospital charges were analyzed. Prolonged LOS and high charges were defined as values above the 75th percentile.

Among 5,305 pediatric patients who underwent tumor resection, 470 received VPS and 140 received ETV. ETV patients were older (7.36 vs. 5.97 years; p = 0.004) and more often female (OR = 2.538; p < 0.001). VPS was associated with higher rates of meningitis, intracranial hemorrhage, tracheostomy, and severe loss of function, while ETV was associated with a higher rate of CSF leak. ETV patients had reduced odds of prolonged LOS (OR = 0.436; p = 0.002), lower total charges (OR = 0.083; p < 0.001), and a greater likelihood of routine discharge (OR = 2.078; p = 0.001). Mortality did not differ significantly between the groups.

In this national cohort, ETV was associated with fewer acute complications and lower hospital resource utilization compared to VPS. These findings suggest ETV may be a preferable CSF diversion strategy in select pediatric patients with hydrocephalus following PFBT resection.