Factors related to the development of shunt-dependent hydrocephalus following subarachnoid hemorrhage in the elderly

Abstract

Evaluating risk factors can help identify patients at high risk of developing shunt-dependent hydrocephalus. Identifying these risk factors may help neurosurgeons to provide optimal therapy and improve outcomes in patients with SAH.

Development of machine learning models to prognosticate chronic shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage

“…Several studies have tried to identify potential predictors of shunt-dependency to estimate prognosis, to offer the best treatment strategy by preventing complications associated with unnecessary treatment or delayed surgical intervention, and to reduce hospitalization and rehabilitation length and costs [1, 5, 8, 9, 11-13, 16, 17, 21-23, 25, 27, 29, 31, 33, 35, 36, 39, 43, 46-48, 50]. Among these variables, some have been proposed, like the patient's age and gender [22,23,33,35,36,47,48], the neurological status at presentation (Hunt & Hess and WFNS scales) [12, 20-22, 25, 27, 47, 48], the amount of cisternal blood on the first CT scan (Fisher and BNI scales) [12, 16, 21-23, 25, 35, 47], the presence of acute hydrocephalus on the first CT scan and the need for external ventricular drain (EVD) [1, 12, 21-23, 25, 27, 33, 36, 43, 47, 48], the duration of EVD treatment [25,48], aneurysms location and size [9,22,25,33,36,47], the type of treatment for aneurysm exclusion (endovascular or surgical) [9,25,35,36,50], the onset and duration of posttreatment complications (i.e., fever and/or infections) [25,27,36,47,50], the duration of blood clearance detected on serial CT scans [29], and altered values of blood or cerebrospinal fluid (CSF) markers [27,31,46]. Some meta-analyses [11,45,47,50] have synthesized this information, and scores fo...…”

“…Several studies have tried to identify potential predictors of shunt-dependency to estimate prognosis, to offer the best treatment strategy by preventing complications associated with unnecessary treatment or delayed surgical intervention, and to reduce hospitalization and rehabilitation length and costs [ 1 , 5 , 8 , 9 , 11 – 13 , 16 , 17 , 21 – 23 , 25 , 27 , 29 , 31 , 33 , 35 , 36 , 39 , 43 , 46 – 48 , 50 ]. Among these variables, some have been proposed, like the patient’s age and gender [ 22 , 23 , 33 , 35 , 36 , 47 , 48 ], the neurological status at presentation (Hunt & Hess and WFNS scales) [ 12 , 20 – 22 , 25 , 27 , 47 , 48 ], the amount of cisternal blood on the first CT scan (Fisher and BNI scales) [ 12 , 16 , 21 – 23 , 25 , 35 , 47 ], the presence of acute hydrocephalus on the first CT scan and the need for external ventricular drain (EVD) [ 1 , 12 , 21 – 23 , 25 , 27 , 33 , 36 , 43 , 47 , 48 ], the duration of EVD treatment [ 25 , 48 ], aneurysms location and size [ 9 , 22 , 25 , 33 , 36 , 47 ], the type of treatment for aneurys...…”

Relationship between external ventricular drain clamp trials and ventriculoperitoneal shunt insertion following nontraumatic subarachnoid hemorrhage: a single-center study

“…ydrocepHalus is a frequent complication of subarachnoid hemorrhage (SAH). 12,15,17,19 The pathophysiological basis for hydrocephalus in these patients includes obstructive mechanisms such as cerebrospinal fluid (CSF) circulation obstruction caused by blood and blood breakdown products, alterations in CSF flow dynamics, and impairment in the absorption of CSF at the arachnoid granulations. 6 An estimated 6.5%-67% of patients with SAH present with acute hydrocephalus.…”

“…14,15 Placement of an EVD in the context of SAH has been reported to be a strong predictor of the need for future VP shunt insertion. 6,12,19 Approximately 15%-52% of patients with EVDs for SAH require VP shunt placement. 6,17,26 Prior studies have looked at patient sex, EVD output volume, CSF content, Hunt and Hess (HH) grade, modified Fisher CT grade, continuous versus intermittent CSF drainage, and rapid versus gradual EVD weaning as factors predictive for VP shunt placement.…”

“…6,17,26 Prior studies have looked at patient sex, EVD output volume, CSF content, Hunt and Hess (HH) grade, modified Fisher CT grade, continuous versus intermittent CSF drainage, and rapid versus gradual EVD weaning as factors predictive for VP shunt placement. 1,6,8,12,15,17,19,27 Even though a clamp trial is part of the process by which patients are weaned from EVDs, there is currently no established standard regarding the number of clamp trials performed before insertion of a VP shunt. This study aims to delineate the relationship between patients who required a VP shunt and the number of clamp trials performed.…”