Ventriculoperitoneal Shunts: Factors Correlated to Revision

Introduction: Ventriculoperitoneal (VP) shunts are one of the most standard cases a neurosurgeon does, however there is incredible variability in how this procedure is completed. We reviewed 713 different shunt procedures and evaluated laparoscopic vs open placement of distal catheter, proximal location, and body mass index (BMI) correlated with revision rate. We also compared laparoscopic vs open placement of distal catheter and OR procedure time.

Methods: This retrospective analysis examined a cohort of 713 patients who underwent VP shunt placement procedures at the UTHealth facility between the 2018 and 2022.

Results: In our study– 68 VP shunts out of 645 initial placements required revisions (~11%). 559 VP shunts were inserted via the laparoscopic technique, whereas 86 were inserted with an open technique. The results of our analysis revealed that there was no statistically significant difference in operating room times between open and laparoscopic placement (p=0.39). There was also no correlation between open vs laparoscopic and revision rate (p=0.25). There were 467 frontal/kocher's point shunts, 100 occipital shunts, and 98 keens point shunts. This was not correlated with revision rate (p=0.50). There were 196 people with an underweight to normal BMI (under 18 to 24), 213 people with an overweight BMI (25-29), and 288 people with an obese BMI (>30). This was not correlated with VP shunt revision (p=0.6).

Conclusion : The placement of VP shunt is one of the most basic life-saving neurosurgical conditions. However there are many different ways to place a VP shunt. In our study we found that open vs laparoscopic placement, BMI and proximal location were not significantly correlated to revision rate. More comprehensive, balanced, and possibly prospective studies are necessary to establish a clearer understanding of the true best way to place a VP shunt.