Discontinuation of External Ventricular Drainage in Patients with Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage - a Scandinavian Multi-institutional Survey

Capion, Tenna; Lilja-Cyron, Alexander; Bartek, Jiri; Forsse, Axel; Logallo, Nicola; Juhler, Marianne; Mathiesen, Tiit

doi:10.1007/s00701-020-04317-6

Cited by 14 publications

(14 citation statements)

References 9 publications

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“…There is no definitive treatment for hydrocephalus, and most patients use a silicone tube and valve system, in which the CSF is transferred from the ventricles to another part of the body [2]. However, shunt therapy is often associated with complications, especially obstruction and infection in infants, increasing morbidity and mortality, and the optimal timing of intervention is unknown [18].…”

Section: Treatmentmentioning

confidence: 99%

“…Non-surgical measures to improve the flow of CSF after aSAH have little effect on the recovery of intracranial pressure, and most patients ultimately require surgical treatment, such as EVD, lumbar drainage, CSF shunts, and ETV [18]. According to clinical guidelines, CSF drainage, such as EVD and lumbar drainage, is recommended to treat acute symptomatic hydrocephalus; EVD (Loe III; Gor B) is recommended for acute hydrocephalus with IVH in the third or fourth ventricle; lumbar drainage is recommended in cases without IVH and supratentorial Hernia (Loe IV; Gor C) [2,16,17].…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…The timing and strategy for stopping ventricular drainage remain controversial. Caption et al surveyed 14 neurosurgical departments in Scandinavia concerning the management of EVD treatment in aSAH patients and found that 85% of respondents said they were unaware of international guidelines for EVD discontinuation in patients with hydrocephalus after aSAH [18]. In 74% of patients, the EVD discontinuation strategy was mainly based on the patient's clinical condition and drainage volume [18].…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…Caption et al surveyed 14 neurosurgical departments in Scandinavia concerning the management of EVD treatment in aSAH patients and found that 85% of respondents said they were unaware of international guidelines for EVD discontinuation in patients with hydrocephalus after aSAH [18]. In 74% of patients, the EVD discontinuation strategy was mainly based on the patient's clinical condition and drainage volume [18]. Besides, Chung et al distributed information about EVD management practices to 72 critical care units in the United States and found that most organizations use a single primary management method of EVD, and the consensus is to continuously open EVD to allow CSF drainage in secure aneurysm patients, at the same time, adopt a gradual weaning strategy [19].…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…Shunting is currently the most widely used surgical treatment for hydrocephalus, but there are often complications, and the optimal timing of intervention is controversial [2,16,17]. Surprisingly, it has been found in one survey that neurosurgeons in some areas used the opposite approach to safety (details in 5.2 Surgical treatment) [18,19].…”

Section: Introductionmentioning

confidence: 99%

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Hydrocephalus after aneurysmal subarachnoid hemorrhage: Epidemiology, Pathogenesis, Diagnosis, and Management

2021

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Hydrocephalus is one of the most common complications of aneurysmal subarachnoid hemorrhage (aSAH), which seriously affects the quality of life and shortens the survival time of affected patients. By reviewing the recent studies on the risk factors of aSAH-associated hydrocephalus, we aimed to explicitly present the pathogenesis of acute and chronic hydrocephalus after aSAH and make a comprehensive list of the associated risk factors of aSAH-associated hydrocephalus and shunt-dependent hydrocephalus. It would help us to better explain the occurrence of hydrocephalus after aSAH, especially hydrocephalus caused by inflammation after bleeding. Many studies have recently suggested that high mobility group box 1 may be an early upstream promoter of inflammatory response after aSAH, which also provides important ideas for us to look for potential drug treatments. The surgery, such as external ventricular drain and lumbar drainage, is the most common and effective treatment. Yet, there are often complications, such as rebleeding and intracranial infection, and the optimal timing of intervention is controversial. Besides, this is also a systematic review of the recent advances in epidemiology, pathogenesis, diagnosis, and management of aSAH-associated hydrocephalus.

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Section: Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hydrocephalus after aneurysmal subarachnoid hemorrhage: Epidemiology, Pathogenesis, Diagnosis, and Management

2021

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Subarachnoid Hemorrhage Management and External Ventricular Drain Placement

Dowlati

Zhou

Felbaum

2022

Introduction to Vascular Neurosurgery

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Predictors of shunt insertion in patients with aneurysmal subarachnoid haemorrhage—a single-centre retrospective analysis

Capion,

Lilja-Cyron,

Olsen

et al. 2024

Acta Neurochir

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Background No standard has been established regarding timing and choice of strategy for discontinuation of external ventricular drainage (EVD) in patients with aneurysmal subarachnoid haemorrhage (aSAH), and little is known about the importance of clinical variables. A proportion of the patients who initially pass their discontinuation attempt return with delayed hydrocephalus and the need of a permanent shunt. Early differentiation between patients who need a shunt and those who do not would facilitate care. We conducted a retrospective analysis on patients with aSAH and an EVD to search significant differences in treatment and clinical variables between patients who received a permanent shunt during initial hospitalization or after readmission, and those who never received a shunt. Methods We included 183 patients with aSAH who received an EVD over a 4-year period between 2015 and 2018 and divided them into three groups: those who received a shunt during primary admission, those who were readmitted for delayed hydrocephalus and received a shunt, and those who never needed a shunt. Between these groups, we compared selected clinical variables as well as outcome at discharge and after 6 months. Additionally, we assessed the ability of a shunt dependency score (SDASH) to predict the need for permanent drainage in the patients. Results Of 183 included patients, 108 (59%) ultimately received a ventriculoperitoneal (VP) shunt. Of these, 89 (82%) failed discontinuation during the primary admission and received a permanent shunt before discharge from the neurosurgical department. The remaining 19 (18%) were discharged after successful discontinuation, but subsequently developed delayed hydrocephalus and were admitted for shunt placement a median of 39 (range: 18–235) days after ictus. Ninety-four patients were discharged after successful discontinuation of the EVD, consisting of those who never developed the need for a permanent shunt and the 19 who were readmitted with delayed hydrocephalus, corresponding to a 20% (19/94) readmittance rate. Clinical variables such as drainage volume or discontinuation strategy did not differ across the three groups of patients. The SDASH score failed to provide any clinically useful information regarding prediction of shunt placement. Conclusion In this study, clinical variables including use of the predictive score SDASH predicted neither the overall need for nor the timing of shunt placement after aSAH. The homogeneous distribution of data between the three different groups renders strong independent clinical predictive factors unlikely. Thus, attempts to predict a permanent shunt requirement from these variables may be futile in these patients.

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Discontinuation of External Ventricular Drainage in Patients with Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage - a Scandinavian Multi-institutional Survey

Cited by 14 publications

References 9 publications

Hydrocephalus after aneurysmal subarachnoid hemorrhage: Epidemiology, Pathogenesis, Diagnosis, and Management

Hydrocephalus after aneurysmal subarachnoid hemorrhage: Epidemiology, Pathogenesis, Diagnosis, and Management

Subarachnoid Hemorrhage Management and External Ventricular Drain Placement

Predictors of shunt insertion in patients with aneurysmal subarachnoid haemorrhage—a single-centre retrospective analysis

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