Success rates and complications of ventriculoperitoneal and ventriculoatrial shunting: A systematic review

Background and Aims: The insertion of ventriculoperitoneal (VP) and ventriculoatrial (VA) shunts is the first-line treatment of patients with hydrocephalus and normal-pressure hydrocephalus. The provision of a safety profile for shunting in the treatment of hydrocephalus patients is very important. This study aimed to determine the success rates and complications of VP and VA shunting in patients with hydrocephalus. Materials and Methods: This systematic review investigated the complication rates of VP and VA shunting in the management of patients with hydrocephalus. All the published studies were searched in three electronic databases, including Google Scholar, PubMed, and Web of Science, within March 20th to April 10th in 2020 using the keywords, namely “Ventriculoperitoneal” and “Ventriculoatrial” in combination with “Hydrocephalus”. Results: Nine articles met the eligibility criteria for being included in this review. Some studies showed a higher rate of shunt obstruction in patients undergoing VA shunting; however, other studies demonstrated no difference in terms of shunt obstruction. The rates of primary revision shunt were various within the ranges of 5.4-48% and 9.1-58% for VA and VP shunting, respectively. A higher rate of revision shunt was reported among the patients undergoing VP shunting in comparison to that reported for those with VA shunting. The different rates of mortality in various studies were estimated within the range of 0-10% and at 13.9% for VA and VP shunting, respectively. Conclusion: In general, no difference was reported in the rates of complications and mortality between VA and VP shunting. Due to the ease of placement and revision, VP shunting could be considered the first-line treatment of hydrocephalus. However, this approach has been preferred in newborns, and there have been insufficient data on adults in this regard