Ventriculoperitoneal Versus Lumboperitoneal Shunt for Post-Hemorrhagic Hydrocephalus: A Multicenter Analysis

Abstract

Ventriculoperitoneal shunt (VPS) is the cornerstone therapy for post-hemorrhagic hydrocephalus (PHH). The optimal shunt strategy for PHH remains inconclusive, as the long-term outcomes of VPS and lumboperitoneal shunt (LPS) are not definitive. This study compared the long-term efficacy and safety of VPS versus LPS and identified specific risk factors for shunt failure in each treatment group. We conducted a retrospective cohort study of adult PHH patients undergoing VPS or LPS at four tertiary centers between 2014 and 2018. The primary outcome was the shunt failure rate at 3 years. Secondary outcomes included complications, the Evans index, and the modified Rankin Scale (mRS) score. To identify risk factors for failure, we performed univariate and multivariate binary logistic regression analyses, stratifying by shunt type. Of the 273 included patients (VPS: 177, LPS: 96), the VPS group demonstrated a significantly lower 3-year shunt failure rate (15.3% vs. 27.1%, p = 0.018) and a higher proportion of favorable outcomes (mRS ≤ 3: 86.4% vs. 72.9%, p = 0.006). Overdrainage was more frequent in the LPS group (12.5% vs. 5.1%, p = 0.028). Multivariate analysis revealed that longer time from hemorrhage to surgery (odds ratio [OR]: 1.143, p = 0.020), elevated cerebrospinal fluid (CSF) protein (OR: 9.003, p < 0.001), and low CSF glucose (OR: 0.458, p = 0.046) were independent risk factors for VPS failure. For LPS, the presence of CSF red blood cells was the sole independent predictor of failure (OR: 12.514, p = 0.019). In conclusion, this study suggests that VPS is associated with superior long-term efficacy and a lower risk of overdrainage compared to LPS in managing PHH. The risk profiles for shunt failure differ between the two procedures, necessitating distinct pre-operative considerations.