Shunt-dependent hydrocephalus after rupture of intracranial aneurysms: a prospective study of the influence of treatment modality

Dehdashti, Amir R.; Rilliet, Bénédict; Rüfenacht, Daniel A.; Tribolet, Nicolas de

doi:10.3171/jns.2004.101.3.0402

Cited by 156 publications

(109 citation statements)

References 43 publications

(41 reference statements)

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“…Also, the influence of the quantity of blood in the subarachnoid space was supported by results from many other studies 7,8,12,18) . Our results showed a total rate of SDHC of 19.7%, which was consistent with results from other series found in the literature 4,5,8,16) . Based on our data, 0% of shunttreated patients were in FG 1, with 11.7% in FG 2, 51% in FG 3, and 37.3% in FG 4.…”

Section: Discussionsupporting

confidence: 83%

“…Several Risk of Shunt Dependent Hydrocephalus : Clipping vs. Coiling | KH Nam, et al studies have compared the incidence of SDHC according to treatment modality. Most reports revealed that endovascular coiling could be attributed to an increased rate of SDHC 4,5,19) . However, Gruber et al 8) reported that the endovascular treatment group did not suffer SDHC more frequently than the surgical treatment group.…”

Section: Discussionmentioning

confidence: 99%

“…Whether or not incidence of SDHC differs significantly between surgical clipping and endovascular coiling is currently unknown. However, several authors have reported results that demonstrated fewer occurrences of SDHC in the surgical treatment group [3][4][5]19) Another study revealed no difference between the two groups 8) . Early evacuation of cisternal clots during surgery is a possible mechanism for lowering SDHC in the surgical group 8) ; however, this is hypothesized only under thick hemorrhagic conditions.…”

Section: Introductionmentioning

confidence: 99%

“…Suggested risk factors for development of shunt dependent hydrocephalus (SDHC) include location of the aneurysm, Fisher grade (FG) on computed tomography (CT) scan, intraventricular hemorrhage (IVH), and so on 7,13,15,17,20) . Similar to vasospasm, development of hydrocephalus has a strong association with the amount of blood spilled into the subarachnoid space and ventricular system [3][4][5]8) .…”

Section: Introductionmentioning

confidence: 99%

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Risk of Shunt Dependent Hydrocephalus after Treatment of Ruptured Intracranial Aneurysms : Surgical Clipping versus Endovascular Coiling According to Fisher Grading System

Nam

Hamm

Kang

et al. 2010

J Korean Neurosurg Soc

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Objective :The amount of hemorrhage observed on a brain computed tomography scan, or a patient's Fisher grade (FG), is a powerful risk factor for development of shunt dependent hydrocephlaus (SDHC). However, the influence of treatment modality (clipping versus coiling) on the rate of SDHC development has not been thoroughly investigated. Therefore, we compared the risk of SDHC in both treatment groups according to the amount of subarachnoid hemorrhage (SAH). Methods : We retrospectively reviewed 839 patients with aneurysmal SAH for a 5-year-period. Incidence of chronic SDHC was analyzed using each treatment modality according to the FG system. In addition, other well known risk factors for SDHC were also evaluated. Results : According to our data, Hunt-Hess grade, FG, acute hydrocephalus, and intraventricular hemorrhage were significant risk factors for development of chronic SDHC. Coiling group showed lower incidence of SDHC in FG 2 patients, and clipping groups revealed a significantly lower rate in FG 4 patients. Conclusion : Based on our data, treatment modality might have an influence on the incidence of SDHC. In FG 4 patients, the clipping group showed lower incidence of SDHC, and the coiling group showed lower incidence in FG 2 patients. We suggest that these findings could be a considerable factor when deciding on a treatment modality for aneurysmal SAH patients, particularly when the ruptured aneurysm can be occluded by either clipping or coiling.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of Shunt Dependent Hydrocephalus after Treatment of Ruptured Intracranial Aneurysms : Surgical Clipping versus Endovascular Coiling According to Fisher Grading System

Nam

Hamm

Kang

et al. 2010

J Korean Neurosurg Soc

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“…In such patients, CSF hydrodynamics are often only transiently disturbed and tend to normalize 40 to 50 days after SAH in most instances. 2 After this initial period of time, adequate shunt function may not be an important factor in many patients with SAH.…”

mentioning

confidence: 99%

Conversion of external ventricular drains to ventriculoperitoneal shunts after aneurysmal subarachnoid hemorrhage: effects of site and protein/red blood cell counts on shunt infection and malfunction

Rammos

Klopfenstein

Augsburger

et al. 2008

JNS

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A cute hydrocephalus is a common sequela of aneurysmal SAH effectively treated with an EVD. Ultimately, a significant proportion of patients may need conversion of their EVD to a permanent VP shunt due to development of chronic hydrocephalus.Although it is a common neurosurgical practice to convert the EVD to a VP shunt, the available literature offers little guidance regarding the technique and site for the placement of the ventricular catheter. Some neurosurgeons prefer using the same EVD hole, whereas in some units it is common practice to use a new, "fresh" site. Each technique has its own pros and cons. Using the same site that had been used for the EVD provides atraumatic entrance of the proximal catheter into the ventricular system through an established track and minimizes the operative risks of hemorrhage and catheter malpositioning. However, Object. The purpose of this study was to determine the incidence of shunt infection in patients with subarachnoid hemorrhage (SAH) after converting an external ventricular drain (EVD) to a ventriculoperitoneal (VP) shunt using the existing EVD site. The second purpose was to assess the risk of shunt malfunction after converting the EVD to a permanent shunt irrespective of the cerebrospinal fluid (CSF) protein and red blood cell (RBC) counts.Methods. Data obtained in 80 consecutive adult patients (18 men and 62 women, mean age 60.8 years, range 33-85 years) who underwent direct conversion of an EVD to a VP shunt for post-SAH hydrocephalus between August 2002 and March 2007 were retrospectively reviewed. In each patient, the existing EVD site was used to pass the proximal shunt catheter. In no patient was VP shunt insertion delayed based on preoperative RBC or protein counts.Results. The mean period of external ventricular drainage before VP shunt placement was 14.1 days (range 3-45 days). No patient suffered ventriculitis. The mean perioperative CSF protein level was 124 mg/dl (range 17-516 mg/ dl). The mean and median perioperative RBC values in CSF were 14,203 RBCs/mm 3 and 4600 RBCs/mm 3 (range 119-290,000/mm 3 ), respectively. No patient was lost to follow-up. The mean follow-up duration was 24 months (range 2-53 months). Three patients (3.8%) had shunt malfunction related to obstruction of the shunt system after 15 days, 2 months, and 18 months, respectively. There were no shunt-related infections. No patient suffered a clinically significant hemorrhage from ventricular catheter placement after VP shunt insertion.Conclusions. In adult patients with aneurysmal SAH, conversion of an EVD to a VP shunt can be safely done using the same EVD site. In this defined patient population, protein and RBC counts in the CSF do not seem to affect shunt survival adversely. Thus, conversion of an EVD to VP shunt should not be delayed because of an elevated protein or RBC count. (DOI: 10.3171.JNS.2008.109.12.1001 Key WoRDS • communicating hydrocephalus • shunt infection • shunt malfunction • subarachnoid hemorrhage 1001Abbreviations used in this paper: CSF = cerebrospinal fluid...

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Specific Treatment of Aneurysmal Subarachnoid Haemorrhage

Warlow¹,

Gijn²,

Dennis³

et al. 2008

Stroke

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Shunt-dependent hydrocephalus after rupture of intracranial aneurysms: a prospective study of the influence of treatment modality

Abstract: Shunt-dependent hydrocephalus was comparable in the two treatment groups, even in patients with better clinical and radiological grades on admission. Only patients in the endovascular therapy group who had experienced IVH showed a higher likelihood of shunt-dependent hydrocephalus.

Cited by 156 publications

References 43 publications

Risk of Shunt Dependent Hydrocephalus after Treatment of Ruptured Intracranial Aneurysms : Surgical Clipping versus Endovascular Coiling According to Fisher Grading System

Risk of Shunt Dependent Hydrocephalus after Treatment of Ruptured Intracranial Aneurysms : Surgical Clipping versus Endovascular Coiling According to Fisher Grading System

Conversion of external ventricular drains to ventriculoperitoneal shunts after aneurysmal subarachnoid hemorrhage: effects of site and protein/red blood cell counts on shunt infection and malfunction

Specific Treatment of Aneurysmal Subarachnoid Haemorrhage

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