title: Comparison of techniques for ventriculoperitoneal shunting in 523 patients with subarachnoid hemorrhage.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania;
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.forename: Alex
authors.initials: A
authors.lastname: Whiting
authors.forename: Eliza C
authors.initials: EC
authors.lastname: Anderson
authors.forename: Samantha
authors.initials: S
authors.lastname: Witte
authors.forename: Mario
authors.initials: M
authors.lastname: Zanaty
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: David
authors.initials: D
authors.lastname: Hasan
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: Shannon
authors.initials: S
authors.lastname: Hann
authors.forename: George M
authors.initials: GM
authors.lastname: Ghobrial
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D017287:Ventriculoperitoneal Shunt / Q000379:methods*
keywords: SAH = subarachnoid hemorrhage; VPS = ventriculoperitoneal shunt; hydrocephalus; infection; subarachnoid hemorrhage; vascular disorders; ventriculoperitoneal shunt