Faculty Collaboration Database

Risk of Complications with Simultaneous Cranioplasty and Placement of Ventriculoperitoneal Shunt. World Neurosurg 2017 Nov;107:830-833

Date

08/22/2017

Pubmed ID

28823666

DOI

10.1016/j.wneu.2017.08.034

Scopus ID

2-s2.0-85029407105 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

BACKGROUND: The development of hydrocephalus (HCP) necessitating placement of a ventriculoperitoneal shunt (VPS) after decompressive hemicraniectomy occurs at a rate of approximately 5%-15%. The ideal approach for addressing both HCP and a cranial defect remains unclear, and whether concomitant VPS and cranioplasty (CP) increases the risk of complications is uncertain.

METHODS: This is a retrospective cohort study of adult patients who underwent CP and VPS placement for any indication at Harborview Medical Center, Seattle between March 2004 and November 2014 with at least 30 days of follow-up. The primary variable of interest was the timing of CP relative to VPS placement. The outcomes of interest were CP- and VPS-related infections, early (within 1 year of placement) VPS obstruction, and a composite of any of these complications in a single patient.

RESULTS: The rate of composite outcomes was 15% in the subgroup of patients with simultaneous CP and VPS placement, compared with 29% in the subgroup of patients in whom CP and VPS placement were performed separately, a non-statistically significant difference (P = 0.24). Similarly, there was no statistically significant difference between the subgroups in any of the 3 individual outcomes of interest, which remained after accounting for potential covariates in a multivariate regression model.

CONCLUSIONS: In our study population, there was no difference between simultaneous and separate CP and VPS placement with respect to CP infection, VPS infection, and VPS mechanical failure/obstruction. There is equipoise in the current literature regarding the safety of performing these 2 common procedures simultaneously, with studies of similar size and design finding variable degrees of safety of this practice.

Author List

Meyer RM 4th, Morton RP, Abecassis IJ, Barber JK, Emerson SN, Nerva JD, Ko AL, Chowdhary MC, Levitt MR, Chesnut RM

Author

John D. Nerva MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Equipment Failure
Female
Follow-Up Studies
Humans
Hydrocephalus
Logistic Models
Male
Middle Aged
Multivariate Analysis
Postoperative Complications
Proportional Hazards Models
Retrospective Studies
Risk
Skull
Treatment Outcome
Ventriculoperitoneal Shunt