Risk factor and operation influence of intracranial hemorrhage following ventriculoperitoneal shunt

Intracranial hemorrhage is a rare but significant complication of ventriculoperitoneal (VP) shunt surgery. This study aimed to identify and assess the risk factors associated with intracranial hemorrhage in patients undergoing VP shunt surgery. This retrospective study included patients who underwent a VP shunt surgery between January 2021 and July 2023. The patients were stratified into two groups based on whether they had a history of prior neurosurgical procedures. Demographic and clinical variables were analyzed for their correlation with postoperative hemorrhage risk. Postoperative CT confirmed hemorrhage. Univariate and logistic regression analyses were performed. Among the 838 patients, 49 (5.85%) developed intracranial hemorrhage. In the overall cohort, preoperative (P = 0.037) and postoperative anticoagulant or antiplatelet use (P = 0.001), left-sided catheter placement (P = 0.026), and pericatheter edema (P = 0.052) were associated with hemorrhage. In patients without prior neurosurgery, independent predictors included pericatheter edema (P = 0.009), postoperative seizures (P < 0.001), shorter catheter depth (P = 0.022), and left-sided placement (P < 0.001). Postoperative anticoagulant use was significant in patients with prior neurosurgery (P = 0.004). Perioperative anticoagulant and antiplatelet use, left-sided catheter placement, and pericatheter edema are critical risk factors for intracranial hemorrhage after VP shunt surgery. Surgical planning should prioritize the vascular anatomy and minimize anticoagulant exposure.