Predictors of Shunt-Dependent Chronic Hydrocephalus after Aneurysmal Subarachnoid Haemorrhage

Abstract

Introduction: Chronic hydrocephalus is a common complication that can occur after aneurysmal subarachnoid haemorrhage (SAH). The purpose of this study was to investigate clinical risk factors that could predict the occurrence of shunt-dependent chronic hydrocephalus after aneurysmal SAH. Methods: Eighty-eight consecutive patients who underwent either surgery or transarterial endovascular embolization as a treatment for cerebral aneurysm within 72 h -after experiencing SAH from March 2005 to July 2006 were studied retrospectively to assess the risk factors that might predict shunt-dependent chronic hydrocephalus. Clinical and demographic factors were examined, including age, sex, initial admission mean arterial blood pressure (MABP), blood sugar level at admission, fever frequency, initial external ventricular drainage (EVD), Fisher grade, Hunt and Hess grade, intraventricular haemorrhage (IVH) and treatment methods to define predictors of shunt-dependent hydrocephalus. The length of hospital stay and modified Rankin scale recorded 6 months after SAH were also evaluated; these parameters were compared between the shunt-dependent and non-shunt-dependent groups. Results: Of the 88 patients, 22 (25%) underwent shunt placement to treat their chronic hydrocephalus. The average length of hospital stay was 33.9 days for the shunt-treated group and 14 days for the non-shunt-treated group. The non-shunt-treated group scored an average of 1.05 on the modified Rankin scale compared with 2.77 for the shunt-treated group. A univariate analysis revealed that several admission variables were associated with long-term shunt-dependent hydrocephalus: (1) increased age (p = 0.023); (2) initial admission MABP (p = 0.027); (3) a high Fisher grade (p = 0.031); (4) a poor admission Hunt and Hess grade (p = 0.030); (5) the presence of IVH (p = 0.029), and (6) initial EVD (p < 0.0001). The factor most commonly associated with shunt-dependent hydrocephalus over the course of hospital days was fever frequency (p < 0.0001). Conclusions: Chronic hydrocephalus after aneurysmal SAH has a multifactorial aetiology. Understanding the risk factors that predict the occurrence of chronic hydrocephalus may help neurosurgeons to expedite permanent cerebrospinal fluid diversion, which could decrease both the cost and length of hospital stay and prevent further complications.

Aneurysm location and clipping versus coiling for development of secondary normal-pressure hydrocephalus after aneurysmal subarachnoid hemorrhage: Japanese Stroke DataBank

“…[3][4][5][6][7]11,12,16,18,23 On the basis of the evidence of an association between the severity of SAH and the prevalence of subsequent sNPH, many neurosurgeons have believed that several surgical manipulations for facilitating CSF dynamics, such as hematoma evacuation, widening the opening of the cisterns, and fenestration of the lamina terminalis, might help to reduce the subsequent occurrence of sNPH after the surgical treatment of SAH. However, the authors of a recent meta-analysis of 11 nonrandomized studies in which data from 1973 patients were pooled concluded that there was no significant difference in the prevalence of sNPH between the 975 patients who had undergone fenestration of the lamina terminalis and the 998 who had not (p = 0.09).…”

“…The prevalence of sNPH has been reported to be 8.9%-48% in patients with SAH. [1][2][3][4][5][6][7]11,12,16,18,22,23 Acute hydrocephalus coexisting with SAH is known to be one of the most important predictors for sNPH. [3][4][5][6]11,16 Previous studies have shown that severe symptoms at SAH onset and a large amount of subarachnoid blood seen on admission CT images are associated with the development of sNPH.…”

“…[3][4][5][6]11,16 Previous studies have shown that severe symptoms at SAH onset and a large amount of subarachnoid blood seen on admission CT images are associated with the development of sNPH. [3][4][5][6][7][8][9][10][11]12,16,18,23 A posterior circulation location of the ruptured aneurysm and endovascular coil embolization have been reported to be significantly associated with sNPH. 1,[4][5][6][7]12,15,16,22 However, this relationship is controversial, because SAH caused by a posterior circulation aneurysm frequently occurs with severe initial symptoms and acute hydrocephalus, compared to SAH caused by a ruptured anterior circulation aneurysm, which is known to occur with mild symptoms and/or no acute hydrocephalus.…”

Predictors of shunt dependency after aneurysmal subarachnoid hemorrhage: results of a single-center clinical trial

“…While acute HC is present in 15-87 % of cases [4,6,27,33,39], chronic HC has been reported in 9-64 % of aSAH patients [2, 4-8, 19, 20, 27, 33, 36, 38, 39]. These large variations may partly be due to differences in patient cohorts, but may also relate to the fact that criteria for the use of temporary and/or permanent cerebrospinal fluid (CSF) drains differ widely between neurosurgical centers [8,22,23,26,30,35,38].…”

“…Given the risks associated with shunt surgery, proper patient selection is paramount. Even though predictors of shunt dependency such as poor clinical grade at admission, amount of subarachnoid blood, acute HC, fever frequency and mode of aneurysm repair have been identified [5,6,8,26,30,36,38], the selection of individual candidates for shunt surgery remains unclear. Some reports have also contradicted some of the predictors [15].…”