• World Neurosurg · Nov 2020

    Comparative Study

    Concurrent vs Staged Procedures for VPS and Cranioplasty: A 10-year Retrospective Comparative Analysis of Surgical Outcomes.

    • Clayton L Rosinski, Mandana Behbahani, Brett Geever, Anisse N Chaker, Saavan Patel, Ryan Chiu, Jack Zakrzewski, David Rosenberg, Rown Parola, Koral Shah, and Ankit I Mehta.
    • Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois, USA.
    • World Neurosurg. 2020 Nov 1; 143: e648-e655.

    BackgroundMany patients undergoing decompressive craniectomy will develop persistent hydrocephalus before cranioplasty. Therefore, surgeons must decide whether to perform ventriculoperitoneal shunt (VPS) placement and cranioplasty simultaneously or in staged procedures. With limited, conflicting data reported, this decision has often been made by personal preference. The objective of the present study was to compare the surgical outcomes between patients undergoing concurrent or staged VPS placement and cranioplasty.MethodsWe performed a 10-year retrospective comparative analysis of patients who had undergone either simultaneous or staged VPS placement and cranioplasty at a tertiary academic medical center.ResultsOf the 40 patients, 18 had undergone concurrent procedures and 22 had undergone VPS placement before a separate cranioplasty procedure. The concurrent group was significantly older, had more often had the VPS placed in the external ventricular drain site, and had had more patients taking aspirin at surgery. The rates of infection, resorption, and reoperation did not differ significantly, although reoperation showed a trend toward occurring less frequently in the concurrent group. Hospital-acquired infection occurred significantly less frequently in the concurrent patients. The rate of VPS-associated outcomes did not differ significantly between the 2 groups.ConclusionsBecause of the trend toward a reduced reoperation rate, the significantly reduced rate of hospital-acquired infection, and the reduction in the number of surgeries, we recommend that patients awaiting cranioplasty in the setting of persistent hydrocephalus undergo concurrent VPS placement and cranioplasty rather than staged procedures.Copyright © 2020 Elsevier Inc. All rights reserved.

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