Age-based algorithm for ventriculoatrial versus ventriculopleural shunt selection in pediatric hydrocephalus: a synthesis of contemporary evidence

Abstract Background When ventriculoperitoneal (VP) shunting fails or is contraindicated, selection between ventriculoatrial (VA) and ventriculopleural (VPl) shunts remains largely empirical, driven by surgeon preference rather than evidence-based criteria. Despite increasing use of alternative CSF diversions, systematic guidance for terminus selection remains limited. Methods A narrative review synthesized comparative outcomes between VA and VPl shunts from contemporary studies (2015–2024), prio