The risk of ventricular catheter misplacement and intracerebral hemorrhage in shunt surgery for hydrocephalus

Abstract

Ventricular shunt insertion is a commonly performed neurosurgical procedure but few studies evaluate the rates of ventricular catheter (VC) misplacement and postoperative intracerebral hemorrhage (ICH) after shunt surgery. In this study, we evaluated the rate of VC misplacement and ICH after shunt insertion in hydrocephalus patients.A consecutive series of adult patients (n = 240) that received a ventricular shunt for hydrocephalus were included in the study. Misplacement was defined as tip of the VC located in the contralateral ventricle or intraparenchymal. The event of ICH was based on verification of intraparenchymal blood on an early (<48 h) head CT postoperatively. The shunt revision rate within six months postoperatively was compared between patients with and without misplacement of the VC.Misplacement of the VC tip was found in 76 patients (33%); 70 patients with the VC tip in the contralateral ventricle and six patients (3%) with the VC tip intraparenchymal.ICH occurred in 8% of the patients. The shunt revision rate for accurately placed VCs was 17% compared to 21% for misplaced VC (p = 0.37). Proximal shunt failure occurred in 11% of the patients with VC misplacement compared to 5% of the patients with accurate VC placement (p = 0.07).VC misplacement occurred in one third and ICH was evident in 8% of the patients. However, VC misplacement did not significantly increase the shunt revision rate. Still, measures to optimize VC placement may be important to reduce risks following ventricular shunt placement. Keywords: Hydrocephalus, Intracerebral hemorrhage, Shunt surgery, Ventricular catheter, Shunt complication, Cerebrospinal fluid