Endoscopic third ventriculostomy may decrease shunt-dependency in patients with post-hemorrhagic hydrocephalus following aneurysmal subarachnoid hemorrhage

AbstractThis study aims to investigate the characteristics of patients with mild aneurysmal and non-aneurysmal perimesencephalic and non-perimesencephalic subarachnoid hemorrhage (aSAH, pmSAH, npmSAH) with emphasis on admission biomarkers, clinical course, and outcome. A prospective cohort of 115 patients with aSAH (Hunt and Hess 1–3) and of 35 patients without aneurysms (16 pmSAH and 19 npmSAH) admitted between January 2014 and January 2020 was included. Demographic data, blood samples on admission, complications (hydrocephalus, shunt dependency, delayed cerebral ischemia DCI, DCI-related infarction, and mortality), and outcome after 6 months were analyzed. Demographic data was comparable between all groups except for age (aSAH 55 [48–65] vs. npmSAH 60 [56–68] vs. pmSAH 52 [42–60], p = 0.032) and loss of consciousness (33% vs. 0% vs. 0%, p = 0.0004). Admission biomarkers showed poorer renal function and highest glucose levels for npmSAH patients. Complication rate in npmSAH was high and comparable to that of aSAH patients (hydrocephalus, shunt dependency, DCI, DCI-related infarction, mortality), but nearly absent in patients with pmSAH. Favorable outcome after 6 months was seen in 92.9% of pmSAH, 83.3% of npmSAH, and 62.7% of aSAH (p = 0.0264). In this prospective cohort of SAH patients, npmSAH was associated with a complicated clinical course, comparable to that of patients with aSAH. In contrast, such complications were nearly absent in pmSAH patients, suggesting fundamental differences in the pathophysiology of patients with different types of non-aneurysmal hemorrhage. Our findings underline the importance for a precise terminology according the hemorrhage etiology as a basis for more vigilant management of npmSAH patients. NCT02142166, 05/20/2014, retrospectively registered.

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Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy

Journal of Neurosurgery ◽

10.3171/jns.1999.90.1.0153 ◽

1999 ◽

Vol 90 (1) ◽

pp. 153-155 ◽

Cited By ~ 80

Author(s):

Henry W. S. Schroeder ◽

Rolf W. Warzok ◽

Jamal A. Assaf ◽

Michael R. Gaab

Keyword(s):

Subarachnoid Hemorrhage ◽

Computerized Tomography ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Balloon Catheter ◽

Third Ventriculostomy ◽

Safe Procedure ◽

Content Type ◽

Tomography Scanning ◽

Fine Print

✓ In recent years, endoscopic third ventriculostomy has become a well-established procedure for the treatment of various forms of noncommunicating hydrocephalus. Endoscopic third ventriculostomy is considered to be an easy and safe procedure. Complications have rarely been reported in the literature. The authors present a case in which the patient suffered a fatal subarachnoid hemorrhage (SAH) after endoscopic third ventriculostomy.This 63-year-old man presented with confusion and drowsiness and was admitted in to the hospital in poor general condition. Computerized tomography scanning revealed an obstructive hydrocephalus caused by a tumor located in the cerebellopontine angle. An endoscopic third ventriculostomy was performed with the aid of a Fogarty balloon catheter. Some hours postoperatively, the patient became comatose. Computerized tomography scanning revealed a severe perimesencephalic—peripontine SAH and progressive hydrocephalus. Despite emergency external ventricular drainage, the patient died a few hours later.Although endoscopic third ventriculostomy is considered to be a simple and safe procedure, one should be aware that severe and sometimes fatal complications may occur. To avoid vascular injury, perforation of the floor of the third ventricle should be performed in the midline, halfway between the infundibular recess and the mammillary bodies, just behind the dorsum sellae.

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A novel score to predict shunt dependency after aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2016.12.jns162400 ◽

2018 ◽

Vol 128 (5) ◽

pp. 1273-1279 ◽

Cited By ~ 11

Author(s):

Dominik Diesing ◽

Stefan Wolf ◽

Jenny Sommerfeld ◽

Asita Sarrafzadeh ◽

Peter Vajkoczy ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Subarachnoid Hemorrhage ◽

Scoring System ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Receiver Operating Curve ◽

Chronic Hydrocephalus ◽

Predictive Values ◽

Shunt Dependency ◽

Independent Risk Factors

OBJECTIVEFeasible clinical scores for predicting shunt-dependent hydrocephalus (SDHC) after aneurysmal subarachnoid hemorrhage (aSAH) are scarce. The chronic hydrocephalus ensuing from SAH score (CHESS) was introduced in 2015 and has a high predictive value for SDHC. Although this score is easy to calculate, several early clinical and radiological factors are required. The authors designed the retrospective analysis described here for external CHESS validation and determination of predictive values for the radiographic Barrow Neurological Institute (BNI) scoring system and a new simplified combined scoring system.METHODSConsecutive data of 314 patients with aSAH were retrospectively analyzed with respect to CHESS parameters and BNI score. A new score, the shunt dependency in aSAH (SDASH) score, was calculated from independent risk factors identified with multivariate analysis.RESULTSTwo hundred twenty-five patients survived the initial phase after the hemorrhage, and 27.1% of these patients developed SDHC. The SDASH score was developed from results of multivariate analysis, which revealed acute hydrocephalus (aHP), a BNI score of ≥ 3, and a Hunt and Hess (HH) grade of ≥ 4 to be independent risk factors for SDHC (ORs 5.709 [aHP], 6.804 [BNI], and 4.122 [HH]; p < 0.001). All 3 SDHC scores tested (CHESS, BNI, and SDASH) reliably predicted chronic hydrocephalus (ORs 1.533 [CHESS], 2.021 [BNI], and 2.496 [SDASH]; p ≤ 0.001). Areas under the receiver operating curve (AUROC) for CHESS and SDASH were comparable (0.769 vs 0.785, respectively; p = 0.447), but the CHESS and SDASH scores were superior to the BNI grading system for predicting SDHC (BNI AUROC 0.649; p = 0.014 and 0.001, respectively). In contrast to CHESS and BNI scores, an increase in the SDASH score coincided with a monotonous increase in the risk of developing SDHC.CONCLUSIONSThe newly developed SDASH score is a reliable tool for predicting SDHC. It contains fewer factors and is more intuitive than existing scores that were shown to predict SDHC. A prospective score evaluation is needed.

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The long-term outcomes of endoscopic third ventriculostomy in pediatric hydrocephalus, with an emphasis on future intellectual development and shunt dependency

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.7.peds18220 ◽

2019 ◽

Vol 23 (1) ◽

pp. 104-108 ◽

Cited By ~ 1

Author(s):

Sukwoo Hong ◽

Daisuke Hirokawa ◽

Kenichi Usami ◽

Hideki Ogiwara

Keyword(s):

Success Rate ◽

Intellectual Development ◽

Endoscopic Third Ventriculostomy ◽

Full Scale ◽

Third Ventriculostomy ◽

Pediatric Hydrocephalus ◽

Shunt Dependency ◽

Csf Diversion ◽

Ventricle Size

OBJECTIVEThe goal of this study was to clarify the long-term outcome of endoscopic third ventriculostomy (ETV) in pediatric hydrocephalus in light of the ETV Success Score (ETVSS), shunt dependency, and intellectual development.METHODSThe authors retrospectively analyzed pediatric patients with hydrocephalus who underwent ETV between 2002 and 2012 and who were followed for longer than 5 years as a single-center cohort. The data of the patients’ pre- and postoperative status were collected. The relationships between ETVSS and the full-scale IQ as well as shunt dependency were analyzed. The usefulness of ETVSS for repeat ETV and the change of radiological parameters of ventricle size before and after ETV were also analyzed. The success of ETV was defined as no requirement for further CSF diversion procedures.RESULTSFifty ETVs were performed in 40 patients. The average ETVSS was 61 and the success rate at 6 months was 64%. The mean follow-up was 9.9 years (5.2–15.3 years), and the long-term success rate of ETV was 50%. The Kaplan-Meier survival curve continued to show a statistically significant difference among patients with a low, moderate, and high ETVSS, even after 6 months (p = 0.002). After 15 months from the initial ETV, no patients required additional CSF diversion surgery. There was no statistical significance between ETVSS and the long-term full-scale IQ or shunt dependency (p = 0.34 and 0.12, respectively). The radiological improvement in ventricle size was not associated with better future educational outcome.CONCLUSIONSThe ETVSS was correlated with the long-term success rate. After 15 months from the initial ETV, no patients required an additional CSF diversion procedure. The ETVSS was not considered to be correlated with long-term intellectual status.

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Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy

Neurosurgical FOCUS ◽

10.3171/foc.1999.6.4.7 ◽

1999 ◽

Vol 6 (4) ◽

pp. E6 ◽

Cited By ~ 6

Author(s):

Henry W. S. Schroeder ◽

Rolf W. Warzok ◽

Jamal A. Assaf ◽

Michael R. Gaab

Keyword(s):

Subarachnoid Hemorrhage ◽

Computerized Tomography ◽

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Third Ventricle ◽

Balloon Catheter ◽

External Ventricular Drainage ◽

Third Ventriculostomy ◽

Safe Procedure ◽

Tomography Scanning

In recent years, endoscopic third ventriculostomy has become a well-established procedure for the treatment of various forms of noncommunicating hydrocephalus. Endoscopic third ventriculostomy is considered to be an easy and safe procedure. Complications have rarely been reported in the literature. The authors present a case in which the patient suffered a fatal subarachnoid hemorrhage (SAH) after endoscopic third ventriculostomy. This 63-year-old man presented with confusion and drowsiness and was admitted in to the hospital in poor general condition. Computerized tomography scanning revealed an obstructive hydrocephalus caused by a tumor located in the cerebellopontine angle. An endoscopic third ventriculostomy was performed with the aid of a Fogarty balloon catheter. Some hours postoperatively, the patient became comatose. Computerized tomography scanning revealed a severe perimesencephalic-peripontine SAH and progressive hydrocephalus. Despite emergency external ventricular drainage, the patient died a few hours later. Although endoscopic third ventriculostomy is considered to be a simple and safe procedure, one should be aware that severe and sometimes fatal complications may occur. To avoid vascular injury, perforation of the floor of the third ventricle should be performed in the midline, halfway between the infundibular recess and the mamillary bodies, just behind the dorsum sellae.

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Letter to the Editor: Risk factors for shunt dependency after aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2016.5.jns161244 ◽

2017 ◽

Vol 126 (2) ◽

pp. 652-654 ◽

Cited By ~ 1

Author(s):

Zhiyi Xie ◽

Xin Hu ◽

Hao Li ◽

Sen Lin ◽

Chao You

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Letter To The Editor ◽

Shunt Dependency

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Meta-analysis and systematic review of risk factors for shunt dependency after aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2015.11.jns152094 ◽

2017 ◽

Vol 126 (2) ◽

pp. 586-595 ◽

Cited By ~ 39

Author(s):

Christopher D. Wilson ◽

Sam Safavi-Abbasi ◽

Hai Sun ◽

M. Yashar S. Kalani ◽

Yan D. Zhao ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Risk Factor ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Meta Analysis ◽

Statistical Significance ◽

Level Of Evidence ◽

Fisher Grade ◽

Shunt Dependency

OBJECTIVE Aneurysmal subarachnoid hemorrhage (aSAH) may be complicated by hydrocephalus in 6.5%–67% of cases. Some patients with aSAH develop shunt dependency, which is often managed by ventriculoperitoneal shunt placement. The objectives of this study were to review published risk factors for shunt dependency in patients with aSAH, determine the level of evidence for each factor, and calculate the magnitude of each risk factor to better guide patient management. METHODS The authors searched PubMed and MEDLINE databases for Level A and Level B articles published through December 31, 2014, that describe factors affecting shunt dependency after aSAH and performed a systematic review and meta-analysis, stratifying the existing data according to level of evidence. RESULTS On the basis of the results of the meta-analysis, risk factors for shunt dependency included high Fisher grade (OR 7.74, 95% CI 4.47–13.41), acute hydrocephalus (OR 5.67, 95% CI 3.96–8.12), in-hospital complications (OR 4.91, 95% CI 2.79–8.64), presence of intraventricular blood (OR 3.93, 95% CI 2.80–5.52), high Hunt and Hess Scale score (OR 3.25, 95% CI 2.51–4.21), rehemorrhage (OR 2.21, 95% CI 1.24–3.95), posterior circulation location of the aneurysm (OR 1.85, 95% CI 1.35–2.53), and age ≥ 60 years (OR 1.81, 95% CI 1.50–2.19). The only risk factor included in the meta-analysis that did not reach statistical significance was female sex (OR 1.13, 95% CI 0.77–1.65). CONCLUSIONS The authors identified several risk factors for shunt dependency in aSAH patients that help predict which patients are likely to require a permanent shunt. Although some of these risk factors are not independent of each other, this information assists clinicians in identifying at-risk patients and managing their treatment.

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THIRD VENTRICULOSTOMY THROUGH THE FENESTRATED LAMINA TERMINALIS DURING MICRONEUROSURGICAL CLIPPING OF INTRACRANIAL ANEURYSMS

Neurosurgery ◽

10.1227/01.neu.0000338433.81852.75 ◽

2009 ◽

Vol 64 (3) ◽

pp. 430-435 ◽

Cited By ~ 13

Author(s):

Hanna Lehto ◽

Reza Dashti ◽

Ayşe Karataş ◽

Mika Niemelä ◽

Juha A. Hernesniemi

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Pressure ◽

Intracranial Aneurysms ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Third Ventricle ◽

Senior Author ◽

Third Ventriculostomy ◽

Lamina Terminalis ◽

High Grade ◽

Safe Alternative

Abstract OBJECTIVE Fenestration of the lamina terminalis (LT) is an alternative means of cerebrospinal fluid (CSF) drainage during acute or emergency surgery of ruptured intracranial aneurysms in patients with high-grade subarachnoid hemorrhage. External ventricular drainage allows drainage of CSF and also measurement of intracranial pressure after the surgery. Catheterization of the third ventricle via the fenestrated LT after clipping the aneurysm is an alternative to conventional ventriculostomies. This method has been used by the senior author (JAH) since 2001. The authors describe their experience with this technique, which can be used safely in selected cases of high-grade subarachnoid hemorrhage. METHODS Seventy-eight patients with aneurysmal subarachnoid hemorrhage underwent third ventriculostomy via the LT between March 2001 and December 2005. Clinical and radiological data of these consecutive patients were retrospectively reviewed. RESULTS There were no procedure-related complications. Eight patients (10%) later required a conventional ventriculostomy, 7 because of catheter occlusion and 1 because of catheter displacement. In 7 patients (9%), a positive CSF culture was found. CONCLUSION Ventriculostomy via the fenestrated LT performed during aneurysm surgery is a practical way for later CSF removal and intracranial pressure monitoring. The catheter can be applied via the same craniotomy without the need for an additional intervention. No procedure-related complications were observed in the present series. This technique can be suggested as a safe alternative to a classical ventriculostomy.

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