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Ventriculostomy with subsequent ventriculoperitoneal shunt placement after subarachnoid hemorrhage: the effect of implantation site on postoperative complications—a single-center series

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

Patients suffering from aneurysmal subarachnoid hemorrhage (SAH) with shunt-dependent hydrocephalus require subsequent placement of a ventriculoperitoneal shunt (VPS) after ventriculostomy. However, in patients with previous ventriculostomy, the site for proximal VPS catheter placement is still controversial. We investigated the effect of catheter placement on postoperative complications by analyzing patients with ventriculostomy and subsequent VPS placement after SAH.

Methods

From January 2004 to December 2018, 164 of 1128 patients suffering from SAH underwent subsequent VPS placement after ventriculostomy in the authors’ institution. Patients were divided into two groups according to the position of the ventriculostomy and the site of the proximal VPS catheter (“same site” group versus “contralateral site” group). VPS-related infectious and bleeding complications following VPS placement were assessed and analyzed.

Results

Overall, VPS-related infections occurred in 11 of the 164 patients (7%). Furthermore, five of the 164 patients (3%) suffered from VPS-related hemorrhage. However, VPS infection rate was lower 5% (6/115) in the same site compared to 10% (5/49) in the contralateral site group, although without reaching statistical significance (OR = 0.48 (0.14, 1.67) 95% confidence interval, p = 0.3). VPS-related hemorrhage rate did not differ significantly between patients in the same site group (3.5%, 4/115) and the contralateral site group (2.0%, 1/49; OR = 1.73 (0.18, 15.9), p = 1.0).

Conclusions

Our study suggests that the use of the ventriculostomy site for VPS placement does not significantly increase the risk of either VPS-related infections or VPS-related hemorrhages.

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Abbreviations

AH:

acute hydrocephalus

CH:

chronic hydrocephalus

CSF:

cerebrospinal fluid

CT:

computed tomography

DC:

decompressive hemicraniectomy

EVD:

external ventricular drainage

ICP:

intracranial pressure

IVH:

intraventricular hemorrhage

SAH:

subarachnoid hemorrhage

VPS:

ventriculoperitoneal shunt

WFNS:

World Federation of Neurological Surgeons scale

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Acknowledgments

We would like to thank Dr. Andrew Richford for language editing.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Bonn, Bonn, Germany

    Inja Ilic, Patrick Schuss, Valeri Borger, Alexis Hadjiathanasiou, Hartmut Vatter & Erdem Güresir

  2. Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany

    Rolf Fimmers

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  1. Inja Ilic
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  2. Patrick Schuss
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  3. Valeri Borger
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  4. Alexis Hadjiathanasiou
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Correspondence to Inja Ilic.

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The authors declare that they have no conflict of interest.

Ethical approval and consent to participate

All aspects of this study were approved by the ethics committee of the Rheinische Friedrich-Wilhelms-University, Bonn, Germany (No. 379/16). Due to the retroperspective character of the study, patient consent was not required. All procedures were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Ilic, I., Schuss, P., Borger, V. et al. Ventriculostomy with subsequent ventriculoperitoneal shunt placement after subarachnoid hemorrhage: the effect of implantation site on postoperative complications—a single-center series. Acta Neurochir 162, 1831–1836 (2020). https://doi.org/10.1007/s00701-020-04362-1

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  • DOI: https://doi.org/10.1007/s00701-020-04362-1

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