Characteristics of delayed intracerebral hemorrhage after ventriculoperitoneal shunt insertion

Abstract

BackgroundDelayed intracerebral hemorrhage after ventriculoperitoneal (VP) shunt insertion is rare and has not been well investigated previously. Its characteristics is still unknown.ObjectiveWe reported 12 patients with delayed intracerebral hemorrhage after VP shunt to investigate the potential risk factors and the outcome.Results12 patients (1.59%) of all the 754 hydrocephalus had delayed intracerebral hemorrhage after VP shunt insertion. 4 patients were women and 8 patients were men, ranging in age from 50 to 76 years. The delayed cerebral hemorrhage from day 3 to day 7 post operation was diagnosed by repeated CT. The delayed intracerebral hemorrhage was significantly related to age, prior craniotomy operation history and manipulation of valve system (3–7 days). Neither gender sexuality nor potential risk factors for postoperative hemorrhage (including anticoagulation/antiplatelet status, liver disease, diabetes, hypertension), time of shunt attempt affected the happen of delayed intracerebral hemorrhage.Materials and MethodsThe clinical characteristics including sex, age, anticoagulation/antiplatelet status, liver disease, diabetes, hypertension, craniotomy operation history, manipulation of valve system and time of shunt attempt of 754 patients who were surgically treated of VP shunt at the first affiliated hospital of Soochow University between 2007 and 2013 were reviewed retrospectively. The potential risk factors of the delayed intracerebral hemorrhage were statistically analyzed.ConclusionsThis study summarizes the presentation and outcome of a series of 12 patients with delayed intracerebral hemorrhage after VP shunt. Age ≥ 60 years, prior craniotomy operation and manipulation of the valve system are statistically significant to the delayed hematoma secondary to VP shunt.

A New Inflammatory Parameter Can Predict Delayed Intracranial Hemorrhage Following Ventriculoperitoneal Shunt

“…As for our study, we excluded the patients with anticoagulant or antiplatelet therapy in order to control the confounding factors, and we found that preoperative PT, APTT, INR and PLT were not risk factors for DICH. Two articles presented that postoperative manipulation of valve system might be a risk factor for DICH secondary to VP shunt 4,15 , which was not supported (P = 0.382) in our study either.…”

“…Nevertheless, this difference was not found in our study (P = 0.674). Advanced age, history of craniotomy were considered to be the risk factors for DICH secondary to VP shunt in several articles [15][16][17][18] , and these factors might increase the fragility of cerebral tissue. However, one article published in 2017 reported that there was no difference between two groups with respect to age 17 .…”

A new inflammatory parameter can predict delayed intracranial hemorrhage following ventriculoperitoneal shunt

“…DICH is one of complications of VP shunt surgery and was first reported in 1985 17 . It was considered to be a rare complication with incidence varies from 0.4 to 4% 4 , 5 , 8 , 9 , 18 . However, the incidence might be underestimated.…”

“…Nevertheless, this difference was not found in our study. Advanced age, history of craniotomy were considered to be the risk factors for DICH secondary to VP shunt in several articles 8 – 11 , and these factors might increase the fragility of cerebral tissue. However, one article published in 2017 reported that there was no difference between two groups with respect to age 10 .…”

“…The risk factors and underlying mechanisms of DICH are still not fully elucidated. There are several risk factors proposed by previously published articles 8 – 11 : (1) advanced age, age ≥ 60 years; (2) history of craniotomy; (3) delayed partial thromboplastin time (PTT); (4) brain edema around catheter; (5) postoperative manipulation of valve system; (6) postoperative anticoagulation.…”