III. Ventricle diameter increase during ventricular drainage challenge – A predictor of shunt dependency after subarachnoid hemorrhage

Abstract BACKGROUND Chronic posthemorrhagic hydrocephalus necessitating shunt placement is a common complication of subarachnoid hemorrhage (SAH). OBJECTIVE To evaluate the role of external ventricular drainage (EVD) weaning on risk of shunt dependency after SAH. METHODS Two German university hospitals with different EVD management regimes (rapid weaning [RW] vs gradual weaning [GW]) pooled the data of their observational cohorts containing altogether 1171 consecutive SAH patients treated between January 2005 and December 2012. Development and timing of shunt dependency in SAH survivals were the endpoints of the study. RESULTS The final cohort consisted of 455 and 510 SAH survivors treated in the centers with RW and GW, respectively. Mortality rates, as well as baseline demographic, clinical, and radiographic parameters, showed no differences between the centers. Patients with GW were less likely to develop shunt dependency (27.5% vs 34.7%, P = .018), Multivariate analysis confirmed independent association between RW regime and shunt dependency (P = .026). Shunt-dependent SAH patients undergoing GW required significantly longer time until shunting (mean 29.8 vs 21.7 d, P < .001) and hospital stay (mean 39 vs 34.4 d, P = .03). In addition, patients with GW were at higher risk for secondary shunt placement after successful initial weaning (P = .001). The risk of cerebrospinal fluid infection was not associated with the weaning regime (15.3% vs 12.9%, P = .307). CONCLUSION At the expense of longer treatment, GW may decrease the risk of shunt dependency after SAH without an additional risk for infections. Due to the risk of secondary shunt dependency, SAH patients with GW require proper posthospital neurological care.

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Risk Factors for Shunt Dependency after Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis including 25 Years of Data

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0036-1580084 ◽

2016 ◽

Vol 77 (S 01) ◽

Author(s):

Sam Safavi-Abbasi ◽

Christopher Wilson ◽

Robert Spetzler

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Meta Analysis ◽

Shunt Dependency

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

Interdisciplinary Neurosurgery ◽

10.1016/j.inat.2021.101300 ◽

2021 ◽

pp. 101300

Author(s):

Luca H. Debs ◽

Scott Y. Rahimi ◽

Martin J. Rutkowski ◽

Samuel D. Macomson

Keyword(s):

Subarachnoid Hemorrhage ◽

Endoscopic Third Ventriculostomy ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Third Ventriculostomy ◽

Shunt Dependency

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Baseline characteristics and outcome for aneurysmal versus non-aneurysmal subarachnoid hemorrhage: a prospective cohort study

Neurosurgical Review ◽

10.1007/s10143-021-01650-x ◽

2021 ◽

Author(s):

Catharina Conzen ◽

Miriam Weiss ◽

Walid Albanna ◽

Katharina Seyfried ◽

Tobias P. Schmidt ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Prospective Cohort ◽

Clinical Course ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Demographic Data ◽

Delayed Cerebral Ischemia ◽

Perimesencephalic Subarachnoid Hemorrhage ◽

Glucose Levels ◽

Shunt Dependency ◽

Baseline Characteristics

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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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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