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

doi:10.3171/2014.6.JNS132638

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

Journal article

Peer reviewed

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, …

Journal of neurosurgery, Vol.121(4), pp.904-907

10/2014

DOI: 10.3171/2014.6.JNS132638

PMID: 25036200

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Abstract

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. 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). 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). 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.

Hydrocephalus - surgery

Humans

Middle Aged

Ventriculoperitoneal Shunt - methods

Female

Hydrocephalus - etiology

Male

Subarachnoid Hemorrhage - complications

Details

Title: Subtitle: Comparison of techniques for ventriculoperitoneal shunting in 523 patients with subarachnoid hemorrhage
Creators: Nohra Chalouhi - Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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
Resource Type: Journal article
Publication Details: Journal of neurosurgery, Vol.121(4), pp.904-907
DOI: 10.3171/2014.6.JNS132638
PMID: 25036200
NLM abbreviation: J Neurosurg
ISSN: 0022-3085
eISSN: 1933-0693
Publisher: United States
Language: English
Date published: 10/2014
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
Record Identifier: 9984040397202771

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