Enhancing reporting standards and cumulative evidence in ventriculoperitoneal shunt studies: a systematic review and reporting guideline proposal

OBJECTIVE: Ventriculoperitoneal shunt (VPS) placement remains the primary treatment for hydrocephalus. However, the literature on this topic is heterogeneous, with studies assessing and reporting surgical and clinical outcomes in different ways, lacking standardization. The authors aimed to evaluate the quality of these studies and propose a reporting guideline focusing on essential elements to ensure reproducibility and comparability. METHODS: Following PRISMA guidelines, the authors systematically searched PubMed, Embase, Web of Science, and the Cochrane Library databases. Eligible studies were observational or randomized, reported clinical and/or surgical outcomes related to the treatment of hydrocephalus with VPS placement, included more than 200 patients, and were published in the English language between January 1, 2000, and June 1, 2024. Studies were assessed and focused on 6 key domains: 1) baseline characteristics of the patient sample; 2) study methodology and reporting guidelines; 3) patient comorbidities and clinical status; 4) valve and shunt characteristics; 5) shunt failure, revision, and infection; and 6) postsurgical outcomes and complications. RESULTS: Forty-five studies comprising 95,597 patients were included. The authors' assessment revealed substantial gaps in the literature on VPS placement, including deficiencies across all domains. A VPS reporting guideline was developed, consisting of 50 items distributed across 6 domains, focusing on key surgical and clinical outcomes. CONCLUSIONS: This review identified important gaps in methodological rigor and reporting across VPS studies for hydrocephalus, limiting the comparability and reproducibility of current evidence. To address these issues, the authors propose the VPS Reporting Guideline, a practical framework to enhance transparency, reproducibility, and comparability in future research, ultimately supporting better evidence synthesis and building of cumulative evidence.