Safety and functional outcome analysis of ventriculoperitoneal shunt placement for hydrocephalus within the critical phase of possible delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Abstract

Shunt-dependent hydrocephalus (HC) is a common sequela following subarachnoid hemorrhage (SAH). However, there is still poor evidence regarding the optimal timing of ventriculoperitoneal shunt (VPS) placement, particularly in the context of early SAH-associated complications such as delayed cerebral ischemia (DCI). The purpose was to compare the impact of early (< 21 days after SAH) versus late (≥ 21 days after SAH) VPS placement on the functional clinical outcome. MethodsWe retrospectively analyzed data from 92 patients with VPS placement after SAH enrolled in our institutional database between 2011 and 2021. We compared two groups, early VPS placement (< 21 days after SAH) versus late VPS placement (≥ 21 days after SAH). ResultsWe identi ed 62 patients with early and 30 patients with late VPS implantation. The modi ed Rankin Scale (mRS; p = 0.3), the World Federation of Neurological Surgeons Scale, the Glasgow Coma Scale, and Fisher grade were not signi cantly different between the groups. Postoperatively, the mRS (p = 0.002), the Glasgow Outcome Scale (p = 0.002), and the extended Glasgow Outcome Scale (p = 0.0028) showed signi cantly better functional results in patients with early cerebrospinal uid diversion. The rate of DCI did not differ signi cantly between the groups (p = 0.45). There was no difference in the rate of VPS placement associated complications (p = 0.38) or overall mortality (p = 0.35). ConclusionsEarly shunt implantation, within 21 days after SAH and during the time of possible DCI, might not be harmful in patients developing HC after SAH.