Hydrocephalus is common among children with myelomeningocele and is most frequently treated with a ventriculoperitoneal shunt (VPS). Although much is known about factors related to first shunt failure, relatively less data are available about shunt failures after the first one. The purpose of this study was to use a large data set to explore time from initial VPS placement to first shunt failure in children with myelomeningocele and to explore factors related to multiple shunt failures.

Data were obtained from the National Spina Bifida Patient Registry. Children with myelomeningocele who were enrolled within the first 5 years of life and had all lifetime shunt operations recorded in the registry were included. Kaplan-Meier survival curves were constructed to evaluate time from initial shunt placement to first shunt failure. The total number of children who experienced at least 2 shunt failures was calculated. A proportional means model was performed to calculate adjusted hazard ratios (HRs) for shunt failure on the basis of sex, race/ethnicity, lesion level, and insurance status.

In total, 1691 children met the inclusion criteria. The median length of follow-up was 5.0 years. Fifty-five percent of patients (938 of 1691) experienced at least 1 shunt failure. The estimated median time from initial shunt placement to first failure was 2.34 years (95% confidence interval [CI] 1.91–3.08 years). Twenty-six percent of patients had at least 2 shunt failures, and 14% of patients had at least 3. Male children had higher likelihood of shunt revision (HR 1.25, 95% CI 1.09–1.44). Children of minority race/ethnicity had a lower likelihood of all shunt revisions (non-Hispanic Black children HR 0.74, 95% CI 0.55–0.98; Hispanic children HR 0.74, 95% CI 0.62–0.88; children of other ethnicities HR 0.80, 95% CI 0.62–1.03).

Among the children with myelomeningocele, the estimated median time to shunt failure was 2.34 years. Forty-five percent of children never had shunt failure. The observed higher likelihood of shunt revisions among males and lower likelihood among children of minority race/ethnicity illustrate a possible disparity in hydrocephalus care that warrants additional study. Overall, these results provide important information that can be used to counsel parents of children with myelomeningocele about the expected course of shunted hydrocephalus.

脑积水在患有脊髓脊膜膨出的儿童中很常见，最常采用脑室腹膜分流术 (VPS) 进行治疗。尽管人们对与第一次分流故障相关的因素了解很多，但有关第一次分流故障之后的可用数据相对较少。本研究的目的是使用大数据集探讨脊髓脊膜膨出儿童从最初放置 VPS 到第一次分流失败的时间，并探讨与多次分流失败相关的因素。

数据来自国家脊柱裂患者登记处。出生后 5 年内入组且在登记处记录了所有终生分流手术的患有脊髓脊膜膨出的儿童均被纳入其中。构建 Kaplan-Meier 生存曲线来评估从最初放置分流器到第一次分流器失败的时间。计算经历至少 2 次分流失败的儿童总数。采用比例均值模型，根据性别、种族/民族、病变程度和保险状况计算分流失败的调整后风险比 (HR)。

总共有 1691 名儿童符合纳入标准。中位随访时间为 5.0 年。 55% 的患者（1691 名患者中的 938 名）至少经历过 1 次分流失败。从最初放置分流器到首次失败的估计中位时间为 2.34 年（95% 置信区间 [CI] 1.91-3.08 年）。 26% 的患者至少有 2 次分流失败，14% 的患者至少有 3 次分流失败。男孩进行分流修复的可能性更高（HR 1.25，95% CI 1.09-1.44）。少数族裔儿童进行所有分流修复的可能性较低（非西班牙裔黑人儿童 HR 0.74，95% CI 0.55–0.98；西班牙裔儿童 HR 0.74，95% CI 0.62–0.88；其他种族儿童 HR 0.80，95 % CI 0.62–1.03）。

在患有脊髓脊膜膨出的儿童中，分流失败的估计中位时间为 2.34 年。百分之四十五的儿童从未出现过分流失败。观察到的男性分流修复的可能性较高，而少数族裔/族裔儿童的可能性较低，说明脑积水护理可能存在差异，值得进一步研究。总体而言，这些结果提供了重要信息，可用于向脊髓脊膜膨出儿童的父母提供关于分流性脑积水的预期病程的咨询。