Predictors and outcomes of shunt-dependent hydrocephalus in patients with aneurysmal sub-arachnoid hemorrhage

Abstract

BackgroundHydrocephalus following spontaneous aneurysmal sub-arachnoid hemorrhage (SAH) is often associated with unfavorable outcome. This study aimed to determine the potential risk factors and outcomes of shunt-dependent hydrocephalus in aneurysmal SAH patients but without hydrocephalus upon arrival at the hospital.MethodsOne hundred and sixty-eight aneurysmal SAH patients were evaluated. Using functional scores, those without hydrocephalus upon arrival at the hospital were compared to those already with hydrocephalus on admission, those who developed it during hospitalization, and those who did not develop it throughout their hospital stay. The Glasgow Coma Score, modified Fisher SAH grade, and World Federation of Neurosurgical Societies grade were determined at the emergency room. Therapeutic outcomes immediately after discharge and 18 months after were assessed using the Glasgow Outcome Score.ResultsHydrocephalus accounted for 61.9% (104/168) of all episodes, including 82 with initial hydrocephalus on admission and 22 with subsequent hydrocephalus. Both the presence of intra-ventricular hemorrhage on admission and post-operative intra-cerebral hemorrhage were independently associated with shunt-dependent hydrocephalus in patients without hydrocephalus on admission. After a minimum 1.5 years of follow-up, the mean Glasgow outcome score was 3.33 ± 1.40 for patients with shunt-dependent hydrocephalus and 4.21 ± 1.19 for those without.ConclusionsThe presence of intra-ventricular hemorrhage, lower mean Glasgow Coma Scale score, and higher mean scores of the modified Fisher SAH and World Federation of Neurosurgical grading on admission imply risk of shunt-dependent hydrocephalus in patients without initial hydrocephalus. These patients have worse short- and long-term outcomes and longer hospitalization.

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].…”

The effect of fenestration of the lamina terminalis on the incidence of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (FISH)

“…The rate of SDH after anterior circulation aneurysm clipping was reported to range from 9.8% to 36% with an average rate of about 20% , [3,9,21] while the incidence of SDH was less than 5% in patients undergoing fenestration during aneurysm repair. [8] We hypothesize that FLT can reduce the incidence of SDH from 20% to 5%.…”

“…[17–19] Patients with SDH experienced higher mortality, worse short- and long-term prognosis with longer hospital stay. [20,21] Moreover, SDH is an independent risk factor predicting long-term unfavorable functional outcome of aSAH. [20] …”

Prediction of ventriculoperitoneal shunt placement based on type of failure during external ventricular drain wean

“…7-65% of patients with subarachnoid hemorrhage (SAH) require external ventricular drain (EVD) placement [1,2] to facilitate cerebrospinal fluid (CSF) drainage to treat symptomatic hydrocephalus or to promote brain relaxation during aneurysm clipping [3,4]. …”

“…Previous studies that evaluated predictors of VPS placement explored a wide variety of variables, including age [8,10-12,14,15], sex [8,10-12], presence of comorbidities [15], intubation status on admission, initial Glasgow Coma Scale (GCS) [12,14], initial Hunt Hess [6,8-11,16] and Fisher scores [5,10,11,14,16,17], admission glucose [17], aneurysm location [8,10-12] aneurysm size [8,12] treatment method (clip versus coil) [9,10,12,15,16], third ventricle diameter at admission [6], intraventricular hemorrhage (IVH) [2,5,8,10,11,16], vasospasm [8], admission CSF red blood cells (RBC) and protein [6,9], ventriculitis [11,17], and number of EVD days [9]. Of these, the most reproducible factors include age, sex, Hunt Hess and Fisher scores, and the existence of many others suggests that local practice may influence the decision to place a VPS.…”