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Updated: Feb 24, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Risk of Complications with Simultaneous Cranioplasty and Placement of Ventriculoperitoneal Shunt
R Michael Meyer1, Ryan P Morton1, Isaac Josh Abecassis1
1Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
Insights
Simultaneous placement of ventriculoperitoneal shunt (VPS) and cranioplasty (CP) after decompressive hemicraniectomy showed no increased risk of complications compared to separate procedures. This finding suggests equipoise regarding the safety of combined VPS and CP surgery.
Area of Science:
- Neurosurgery
- Surgical Outcomes
- Cranial Reconstruction
Background:
- Hydrocephalus (HCP) requiring ventriculoperitoneal shunt (VPS) placement occurs in 5-15% of patients post-decompressive hemicraniectomy.
- Optimal management of concurrent HCP and cranial defects, alongside the safety of simultaneous VPS and cranioplasty (CP), remains uncertain.
Purpose of the Study:
- To evaluate the safety and complication rates of simultaneous versus staged VPS and CP placement.
- To compare CP- and VPS-related infections and early VPS obstruction between the two procedural timing groups.
Main Methods:
- Retrospective cohort study of adult patients undergoing CP and VPS placement between 2004-2014.
- Primary analysis focused on the timing of CP relative to VPS placement (simultaneous vs. separate).
- Outcomes included CP/VPS infections, early VPS obstruction, and a composite of these complications.
Main Results:
- The composite outcome rate was 15% for simultaneous CP/VPS placement versus 29% for separate procedures (P=0.24).
- No statistically significant differences were observed in individual outcomes (CP infection, VPS infection, VPS obstruction) between the groups.
- These findings persisted after adjusting for covariates in multivariate regression analysis.
Conclusions:
- Simultaneous CP and VPS placement did not result in a higher incidence of infection or mechanical failure compared to separate procedures.
- The study indicates equipoise in the literature regarding the safety of performing these procedures concurrently.
- Further research is needed to definitively establish the optimal timing for VPS and CP placement.
Background:
The development of hydrocephalus (HCP) necessitating placement of a ventriculoperitoneal shunt (VPS) after decompressive hemicraniectomy occurs at a rate of approximately 5%-15%. The ideal approach for addressing both HCP and a cranial defect remains unclear, and whether concomitant VPS and cranioplasty (CP) increases the risk of complications is uncertain.
Methods:
This is a retrospective cohort study of adult patients who underwent CP and VPS placement for any indication at Harborview Medical Center, Seattle between March 2004 and November 2014 with at least 30 days of follow-up. The primary variable of interest was the timing of CP relative to VPS placement. The outcomes of interest were CP- and VPS-related infections, early (within 1 year of placement) VPS obstruction, and a composite of any of these complications in a single patient.
Results:
The rate of composite outcomes was 15% in the subgroup of patients with simultaneous CP and VPS placement, compared with 29% in the subgroup of patients in whom CP and VPS placement were performed separately, a non-statistically significant difference (P = 0.24). Similarly, there was no statistically significant difference between the subgroups in any of the 3 individual outcomes of interest, which remained after accounting for potential covariates in a multivariate regression model.
Conclusions:
In our study population, there was no difference between simultaneous and separate CP and VPS placement with respect to CP infection, VPS infection, and VPS mechanical failure/obstruction. There is equipoise in the current literature regarding the safety of performing these 2 common procedures simultaneously, with studies of similar size and design finding variable degrees of safety of this practice.
