Comparison of failure rates between full-barium and striped barium distal shunt catheters: a matched case-control study.

Purpose: We hypothesize that distal shunt catheters fully impregnated with barium are more prone to failure compared to distal catheters with only a barium stripe. We sought to evaluate this distinction using a matched case-control study.

Methods: Patient records over an 8-year period were queried for distal shunt revisions for fracture or disconnection (cases). A control group of patients with confirmed functioning distal catheters was queried from the same period and matched based on patient age at exploration/revision. Data were collected via chart review, including demographics, hydrocephalus etiology, distal catheter type, and patient age at revision. Independent T-test, chi-squared, and binomial logistic regression analyses were performed.

Results: There were 194 patients included in the study: 97 patients with distal shunt revision and 97 controls with a functional distal shunt system. The mean patient age at distal catheter revision was 12.87 ± 4.59 years, and the mean patient age of the control group was 12.81 ± 4.59 years. The most common etiology was premature intraventricular hemorrhage (32%). Of the distal failures, 41.2% had fully impregnated barium catheters, while 58.8% had striped barium catheters. Of the control group, 76/97 (78%) patients had barium-striped distal shunt catheters and 21/97 (22%) had fully impregnated catheters. Logistic regression analysis showed that fully impregnated catheters were more likely than striped barium to fail, p = 0.004 (OR = 2.54, 95% CI 1.35-4.77).

Conclusion: In a matched case-control format, odds of failure of fully impregnated distal catheters were 2.54 greater than striped barium catheters.