Safety and Complications of Ventriculoatrial Shunting in Elderly Patients: A Single-Center Retrospective Study.

Abstract

The incidence of cerebrospinal fluid shunting among older adults is increasing. Ventriculoatrial (VA) shunting is a common shunting method, but research on VA shunting for elderly patients is limited. This retrospective study aimed to investigate the complication rate of VA shunting in older patients. Patients aged ≥65 years who underwent VA shunting at Tsukazaki Hospital between January 2019 and September 2023 were included. Follow-up duration, type of valve system, opening pressure, and postoperative complications (including overdrainage, symptomatic intracerebral hemorrhage, perioperative seizure, shunt system revision, infection, cardiopulmonary complications, cranial nerve injury, and other complications) were assessed. Among 115 included patients (55% female and 71% primary hydrocephalus), the mean age and follow-up duration were 78 years and 464 days, respectively. Overdrainage, infection, symptomatic intracranial hemorrhage, and revision occurred in 22%, 2.6%, 1.7%, and 0.9% of patients, respectively. No other complications were observed. Among overdrainage cases, 84% were asymptomatic, and all cases were cured by resetting the opening pressure. Overdrainage was significantly higher among males (odds ratio [OR]: 3.34; 95% confidence interval [CI]: 1.30-8.56; P = 0.0097) and those aged <70 years (OR: 5.38; 95% CI: 1.32-21.84; P = 0.0226), while higher initial opening pressure (≥18 cmH₂O) significantly reduced overdrainage (OR: 0.29; 95% CI: 0.11-0.79; P = 0.0123). All infections were treated using antibiotics, and 1 revision was due to failure of distal catheter implantation. The observed complication rate of VA shunting in elderly patients was no higher compared with that of other age groups or other cerebrospinal fluid shunting techniques, reported in previous studies.