Comparison of techniques for ventriculoperitoneal shunting in 523 patients with subarachnoid hemorrhage

Nohra Chalouhi, Alex Whiting, Eliza C. Anderson, Samantha Witte, Mario Zanaty, Stavropoula Tjoumakaris, L. Fernando Gonzalez, David Hasan, Robert M. Starke, Shannon Hann, George M. Ghobrial, Robert Rosenwasser, Pascal Jabbour

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Object. It is common practice to use a new contralateral bur hole for ventriculoperitoneal shunt (VPS) placement in subarachnoid hemorrhage (SAH) patients with an existing ventriculostomy. At Thomas Jefferson University and Jefferson Hospital for Neuroscience, the authors have primarily used the ventriculostomy site for the VPS. The purpose of this study was to compare the safety of the 2 techniques in patients with SAH.

Methods. The rates of VPS-related hemorrhage, infection, and proximal revision were compared between the 2 techniques in 523 patients undergoing VPS placement (same site in 464 and contralateral site in 59 patients).

Results. The rate of new VPS-related hemorrhage was significantly higher in the contralateral-site group (1.7%) than in the same-site group (0%; p = 0.006). The rate of VPS infection did not differ between the 2 groups (6.4% for same site vs 5.1% for contralateral site; p = 0.7). In multivariate analysis, higher Hunt and Hess grades (p = 0.05) and open versus endovascular treatment (p = 0.04) predicted shunt infection, but the VPS technique was not a predictive factor (p = 0.9). The rate of proximal shunt revision was 6% in the same-site group versus 8.5% in the contralateralsite group (p = 0.4). In multivariate analysis, open surgery was the only factor predicting proximal VPS revision (p = 0.05).

Conclusions. The results of this study suggest that the use of the ventriculostomy site for VPS placement may be feasible and safe and may not add morbidity (infection or need for revision) compared with the use of a fresh contralateral site. This rapid and simple technique also was associated with a lower risk of shunt-related hemorrhage. While both techniques appear to be feasible and safe, a definitive answer to the question of which technique is superior awaits a higher level of medical evidence.

Original languageEnglish (US)
Pages (from-to)904-907
Number of pages4
JournalJournal of neurosurgery
Volume121
Issue number4
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

Keywords

  • Hydrocephalus
  • Infection
  • Subarachnoid hemorrhage
  • Vascular disorders
  • Ventriculoperitoneal shunt

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint

Dive into the research topics of 'Comparison of techniques for ventriculoperitoneal shunting in 523 patients with subarachnoid hemorrhage'. Together they form a unique fingerprint.

Cite this