Comparison of techniques for ventriculoperitoneal shunting in 523 XXXX with @entity510 .

@entity1 @entity281 @entity548 @entity510
Object It is common practice to use a new contralateral bur hole for ventriculoperitoneal shunt (VPS) placement in @entity510 ( @entity510 ) @entity1 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 @entity1 with @entity510 . Methods The rates of VPS-related @entity548 , @entity281 , and proximal revision were compared between the 2 techniques in 523 @entity1 undergoing VPS placement (same site in 464 and contralateral site in 59 @entity1 ). Results The rate of new VPS-related @entity548 was significantly higher in the contralateral-site group (1.7%) than in the same-site group (0%; p = 0.006). The rate of @entity281 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 @entity281 , 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 ( @entity281 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 @entity548 . 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.
