{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T15:03:04Z","timestamp":1775833384290,"version":"3.50.1"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Ventriculoatrial (VA) shunting is rarely used for patients with normal-pressure hydrocephalus (NPH), likely due to surgeon technical preference and case reports indicating cardiopulmonary complications. However, these complications have typically been limited to adults in whom VA shunts had been placed when they were children. Few studies have directly compared VA shunting to ventriculoperitoneal (VP) shunting in cases of NPH.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors retrospectively analyzed all NPH patients treated by a single surgeon at their center from January 2002 through December 2011. Thirty patients were treated with VA shunts (14 male) and 157 with VP shunts (86 male). The patients' mean age (\u00b1 SD) at surgery was 73.7 \u00b1 9.4 years for VA shunting and 76.0 \u00b1 8.2 years for VP shunting; the median durations of follow-up were 42.0 months (IQR 19.2\u201363.6 months) and 34.2 months (IQR 15.8\u201367.5), respectively. Statistical analysis was performed using chi-square tests and Wilcoxon rank-sum tests.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Perioperative and postoperative complications for VA and VP shunting cohorts, respectively, included distal revision (2.7% vs 6.6%, p = 0.45), proximal revision (2.7% vs 2.5%, p = 0.97), and postoperative seizure (2.7% vs 1.5%, p = 0.62). Shunt drainage\u2013related subdural hematomas\/hygromas developed in 8.1%\/27.0% of VA shunt\u2013treated patients versus 6.6%\/26.4% of VP shunt\u2013treated patients (p = 0.76\/0.98) and were nearly always successfully managed with programmable-valve adjustment. Symptomatic intracerebral hemorrhage (1.5%) and shunt infection (2.0%) were only observed in those who underwent VP shunting. Of note, no cardiovascular complications were observed in any patient, and there were no cases of distal occlusion of the VA shunt.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The authors found no significant differences in complication rates between VA and VP shunting, and VA shunting was not associated with any cardiopulmonary complications. Thus, in the authors' experience, VA shunting is at least as safe as VP shunting for treating NPH.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.1.jns131808","type":"journal-article","created":{"date-parts":[[2014,3,7]],"date-time":"2014-03-07T15:00:41Z","timestamp":1394204441000},"page":"1458-1464","source":"Crossref","is-referenced-by-count":53,"title":["Should ventriculoatrial shunting be the procedure of choice for normal-pressure hydrocephalus?"],"prefix":"10.3171","volume":"120","author":[{"given":"Robert A.","family":"McGovern","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen M.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew K.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas J.","family":"Morrissey","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Endovascular Interventions, Columbia University Medical Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guy M.","family":"McKhann","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns131808","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1056\/NEJM196507152730301","article-title":"Symptomatic occult hydrocephalus with \u201cnormal\u201d cerebrospinal-fluid pressure. A treatable syndrome","volume":"273","author":"Adams","year":"1965"},{"issue":"3 Suppl","key":"b2-jns131808","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"S2-29","DOI":"10.1227\/01.NEU.0000168186.45363.4D","article-title":"Surgical management of idiopathic normal-pressure hydrocephalus","volume":"57","author":"Bergsneider","year":"2005"},{"key":"b3-jns131808","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"371","DOI":"10.3171\/jns.1980.52.3.0371","article-title":"Idiopathic normal-pressure hydrocephalus. Results of shunting in 62 patients","volume":"52","author":"Black","year":"1980"},{"key":"b4-jns131808","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"490","DOI":"10.3171\/jns.1998.88.3.0490","article-title":"Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of low-and medium-pressure shunts","volume":"88","author":"Boon","year":"1998"},{"key":"b5-jns131808","series-title":"Brain","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1093\/brain\/105.1.65","article-title":"The predictive value of conductance to outflow of CSF in normal pressure hydrocephalus","volume":"105","author":"B\u00f8rgesen","year":"1982"},{"key":"b6-jns131808","series-title":"J Surg Res","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1016\/j.jss.2005.06.015","article-title":"Normal intraabdominal pressure in healthy adults","volume":"129","author":"Cobb","year":"2005"},{"key":"b7-jns131808","series-title":"Intensive Care Med","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1007\/s00134-009-1445-0","article-title":"What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure?","volume":"35","author":"De Keulenaer","year":"2009"},{"key":"b8-jns131808","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1016\/0090-3019(84)90300-8","article-title":"Thromboembolic complications of ventriculoatrial shunts","volume":"22","author":"Drucker","year":"1984"},{"key":"b9-jns131808","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"68","DOI":"10.3171\/PED\/2008\/2\/7\/068","article-title":"Ventriculoatrial shunt catheter displacement in a child with partial anomalous pulmonary venous return. Case report","volume":"2","author":"Elhammady","year":"2008"},{"issue":"4 Suppl","key":"b10-jns131808","series-title":"J Neurosurg","first-page":"319","article-title":"Endovascular placement of a ventriculoatrial shunt. Technical note","volume":"106","author":"Gonzalez","year":"2007"},{"key":"b11-jns131808","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1136\/jnnp.40.4.336","article-title":"Idiopathic normal pressure hydrocephalus\u2014a report of 73 patients","volume":"40","author":"Greenberg","year":"1977"},{"key":"b12-jns131808","series-title":"Neurosurgery","first-page":"1166","article-title":"Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome","volume":"49","author":"Hebb","year":"2001"},{"key":"b13-jns131808","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1136\/jnnp.41.11.961","article-title":"Adult idiopathic communicating hydrocephalus with and without shunting","volume":"41","author":"Hughes","year":"1978"},{"key":"b14-jns131808","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"679","DOI":"10.3171\/jns.1975.42.6.0679","article-title":"Follow-up analysis of ventriculoperitoneal and ventriculoatrial shunts for hydrocephalus","volume":"42","author":"Ignelzi","year":"1975"},{"key":"b15-jns131808","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"681","DOI":"10.3171\/jns.1971.35.6.0681","article-title":"The ventriculocaval shunt in the treatment of adult hydrocephalus. Results and complications in 101 patients","volume":"35","author":"Illingworth","year":"1971"},{"key":"b16-jns131808","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"179","DOI":"10.3171\/jns.1979.50.2.0179","article-title":"Long-term results after ventriculoatrial and ventriculoperitoneal shunting for infantile hydrocephalus","volume":"50","author":"Keucher","year":"1979"},{"key":"b17-jns131808","series-title":"Aust N Z J Surg","first-page":"372","article-title":"The peritoneal complications of ventriculo-peritoneal shunts","volume":"46","author":"King","year":"1976"},{"key":"b18-jns131808","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.3171\/2010.6.JNS091541","article-title":"Pulmonary hypertension after ventriculoatrial shunt implantation. Clinical article","volume":"113","author":"Kluge","year":"2010"},{"key":"b19-jns131808","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1097\/00006123-199608000-00011","article-title":"Cerebrospinal fluid shunting in idiopathic normal-pressure hydrocephalus of the elderly: effect of periventricular and deep white matter lesions","volume":"39","author":"Krauss","year":"1996"},{"key":"b20-jns131808","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1080\/02688699746681","article-title":"Comparison between ventriculoatrial and ventriculoperitoneal shunting in the adult population","volume":"11","author":"Lam","year":"1997"},{"key":"b21-jns131808","series-title":"Acta Neurol Scand","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1111\/j.1600-0404.1991.tb04998.x","article-title":"Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus","volume":"84","author":"Larsson","year":"1991"},{"key":"b22-jns131808","series-title":"Mayo Clin Proc","first-page":"396","article-title":"Comparison of ventriculoperitoneal and ventriculoatrial shunts for hydrocephalus in children","volume":"47","author":"Little","year":"1972"},{"key":"b23-jns131808","series-title":"Childs Nerv Syst","first-page":"215","article-title":"Fatal cardiopulmonary complications in children treated with ventriculoatrial shunts","volume":"7","author":"Lundar","year":"1991"},{"key":"b24-jns131808","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"153","DOI":"10.3171\/jns.2006.105.1.153","article-title":"Accurate placement of the distal end of a ventriculoatrial shunt with the aid of real-time transesophageal echocardiography. Technical note","volume":"105","author":"Machinis","year":"2006"},{"key":"b25-jns131808","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1227\/00006123-198410000-00002","article-title":"Treatment of normal pressure hydrocephalus with low versus medium pressure cerebrospinal fluid shunts","volume":"15","author":"McQuarrie","year":"1984"},{"key":"b26-jns131808","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"867","DOI":"10.3171\/2008.10.17674","article-title":"Accuracy of percutaneous placement of a ventriculoatrial shunt under ultrasonography guidance: a retrospective study at a single institution. Technical note","volume":"110","author":"Metellus","year":"2009"},{"key":"b27-jns131808","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1608","DOI":"10.1016\/S0140-6736(01)06655-7","article-title":"Late cardiopulmonary complication of ventriculo-atrial shunt","volume":"358","author":"Milton","year":"2001"},{"key":"b28-jns131808","series-title":"Eur Heart J","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1093\/eurheartj\/ehr164","article-title":"Right heart complications of ventriculoatrial shunt","volume":"32","author":"Natarajan","year":"2011"},{"key":"b29-jns131808","series-title":"Acta Paediatr Scand","first-page":"385","article-title":"Complications in the treatment of hydrocephalus in childre. A comparison of ventriculoatrial and ventriculoperitoneal shunts in a 20-year material","volume":"72","author":"Olsen","year":"1983"},{"key":"b30-jns131808","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1227\/00006123-199409000-00006","article-title":"Cognitive recovery in idiopathic normal pressure hydrocephalus: a prospective study","volume":"35","author":"Raftopoulos","year":"1994"},{"key":"b31-jns131808","series-title":"Acta Neurol Scand","first-page":"311","article-title":"Idiopathic normal pressure hydrocephalus: the CSF tap-test may predict the clinical response to shunting","volume":"89","author":"Sand","year":"1994"},{"key":"b32-jns131808","series-title":"World Federation of Neurosurgical Societies","article-title":"Diagnosis and management of shunt complications in the treatment of childhood hydrocephalus","author":"Tamburrini"},{"key":"b33-jns131808","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1007\/s00701-005-0619-y","article-title":"A rare but life-threatening complication of ventriculo-atrial shunt","volume":"147","author":"Tonn","year":"2005"},{"key":"b34-jns131808","series-title":"Surg Neurol","first-page":"271","article-title":"Results and complications in 55 shunted patients with normal pressure hydrocephalus","volume":"3","author":"Udvarhelyi","year":"1975"},{"key":"b35-jns131808","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1227\/00006123-199511000-00005","article-title":"Current treatment of normal-pressure hydrocephalus: comparison of flow-regulated and differential-pressure shunt valves","volume":"37","author":"Weiner","year":"1995"},{"key":"b36-jns131808","series-title":"World Health Organ Tech Rep Ser","first-page":"i","article-title":"Obesity: preventing and managing the global epidemic. Report of a WHO consultation","volume":"894","author":"World Health Organization Consultation on Obesity","year":"2000"},{"key":"b37-jns131808","series-title":"Surg Neurol Int","doi-asserted-by":"publisher","first-page":"10","DOI":"10.4103\/2152-7806.106284","article-title":"Reasons, procedures, and outcomes in ventriculoatrial shunts: a single-center experience","volume":"4","author":"Yavuz","year":"2013"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/120\/6\/article-p1458.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/120\/6\/article-p1458.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/120\/6\/article-p1458.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,24]],"date-time":"2022-07-24T14:12:02Z","timestamp":1658671922000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/120\/6\/article-p1458.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2014,6]]},"references-count":37,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2014.1.jns131808","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,6]]}}}