Incidence and nature of complications associated with ventriculoatrial shunt placement: A systematic review and single-arm meta-analysis

Leonardo de Barros Oliveira; Leonardo Christiaan Welling; Fabio Alex Fonseca Viegas; Luiz Roberto Cavassola Ribas; Elcio Oscar Machinski Junior; Rubens Miguel Wesselovicz; Savio Batista; Raphael Bertani; Lucca Biolcati Palavani; Nicollas Nunes Rabelo; Eberval Gadelha Figueiredo

doi:10.1016/j.clineuro.2023.107950

Incidence and nature of complications associated with ventriculoatrial shunt placement: A systematic review and single-arm meta-analysis

Clin Neurol Neurosurg. 2023 Oct:233:107950. doi: 10.1016/j.clineuro.2023.107950. Epub 2023 Aug 26.

Affiliations

¹ Department of Neurosurgery, State University of Ponta Grossa, Paraná, Brazil. Electronic address: leobarrosoliveira09@gmail.com.
² Department of Neurosurgery, State University of Ponta Grossa, Paraná, Brazil.
³ Department of Neurosurgery, Campos Gerais Regional University Hospital, Brazil.
⁴ Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
⁵ Department of Neurosurgery, University of São Paulo, São Paulo, Brazil.
⁶ Max Planck University Center, Indaiatuba, São Paulo, Brazil.

PMID: 37673013
DOI: 10.1016/j.clineuro.2023.107950

Abstract

Background: Ventriculoatrial shunt (VAS) is considered the second option for treating hydrocephalus, but there remains a lack of robust evidence regarding its complications profile.

Purpose: Evaluate the complications associated with VAS.

Methods: Adhering to PRISMA guidelines, the authors searched Embase, PubMed, and Web of Science databases to identify articles reporting on the complications of VAS. Eligible articles were required to report whether complications occurred in a cohort of at least four patients. The extraction process focused on various outcome measures, including overall complications, pulmonary complications, cardiac complications, mortality, shunt revisions, glomerulonephritis, intracranial hemorrhage, and hygroma. Complications were defined as any adverse events related to the procedure, including revisions.

Results: After retrieving a total of 2828 articles, 53 studies met the predefined criteria, involving 2862 patients. The overall complication rate was estimated at 33 % (95 % CI: 25-42 %), while the long-term complications rate was found to be 49 % (95 % CI: 32-67 %). Among the pediatric population, the complication rate was calculated to be 53 % (95 % CI: 39-68 %). The overall revision rate was estimated at 32 % (95 % CI: 23-41 %), with an infection rate of 5 % (95 % CI: 3-7 %). Notably, in the pediatric group, the infection rate was 10 % (95 % CI: 6-13 %). The random analysis indicated an estimated risk of 0 % for glomerulonephritis, intracranial hemorrhage, hygroma, cardiac complications, pulmonary complications, and shunt-related mortality.

Conclusion: VAS is a safe alternative when ventriculoperitoneal shunting is not feasible. Risk of classic severe complications is minimal. Nevertheless, caution is required when shunting critical patients. Further randomized studies are warranted to establish the ideal shunt for different patients.

Keywords: Hydrocephalus; VA shunt; VAS; Ventriculoatrial shunt; Ventriculoperitoneal shunt.

Publication types

Review