Shunt-Dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage: Predictors and Long-Term Functional Outcomes

Paisan, Gabriella; Ding, Dale; Starke, Robert M.; Crowley, R. Webster; Liu, Kenneth C.

doi:10.1093/neuros/nyx393

Cited by 66 publications

(48 citation statements)

References 22 publications

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“…Delayed cerebral ischemia continues to be an important cause of cognitive impairment and disability after aSAH despite accepted aggressive management [27][28][29]. A single center study including 888 aSAH patients found that shunt dependent hydrocephalus was a strong independent risk factor for unfavorable functional outcome [30]. Our nal results also con rm the predictive role of above-mentioned factors.…”

Section: Discussionsupporting

confidence: 71%

“…Undeniably, more valuable risk variables added into the risk score could improve its predictivity. Treatment methods, shunt-dependent hydrocephalus and delayed cerebral ischemia are three factors that affect the long-term neurological prognosis and cognitive impairment of patients, their role in predicting the prognosis of patients is worthy of recognition [14,30,32,35]. Our PASHPSS have signi cantly improved its discrimination comparing to other risk scores by drawing into these risk factors.…”

Section: Discussionmentioning

confidence: 99%

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A scoring model to predict the prognosis of patients with poor-grade aneurysmal subarachnoid hemorrhage

Shen¹,

Yu²,

Huang³

et al. 2020

Preprint

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Background Patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH), defined as World Federation of Neurosurgical Societies (WFNS) grade IV-V has high rates of disability and mortality. The objective of this research is to prognosticate outcomes of poor-grade aSAH accurately. Methods A total of 147 poor-grade aSAH patients in our center were enrolled. Risk variables identified by multivariate logistic regression were used to devise the scoring model (total score of 0–9 points). The score values were estimated according to β coefficients. A cohort of 68 patients from another institute was used to validate the model. Results Multivariate analysis revealed that modified Fisher grade above II (odds ratio [OR], 2.972; p = 0.034), age ≥ 65 years (OR, 3.534; p = 0.006), conservative treatment (OR, 5.078; p = 0.019), WFNS Grade V (OR, 2.638; p = 0.029), delayed cerebral ischemia (OR, 3.170; p = 0.016), shunt-dependent hydrocephalus (OR, 3.202; p = 0.032) and cerebral herniation (OR, 7.337; p < 0.001) were significant predictors of poor prognosis (modified Rankin Scale [mRS] ≥ 3). By integration of above factors, a scoring system was constructed and divided poor-grade aSAH patients into three categories: low risk (0–1 point), intermediate risk (2–3 points) and high risk (4–9 points), with risk of poor prognosis being 11%, 52% and 87% respectively (P < 0.001). The area under the curve in derivation cohort was 0.844 (p < 0.001; 95% CI, 0.778–0.909). AUC in validation cohort was 0.831 (p < 0.001; 95% CI, 0.732–0.929). Conclusions The new scoring model could improve prognostication of prognosis and help decision-making for subsequent complement treatment.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

A scoring model to predict the prognosis of patients with poor-grade aneurysmal subarachnoid hemorrhage

Shen¹,

Yu²,

Huang³

et al. 2020

Preprint

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“…Some studies suggest that high CSF viscosity can lead to an obstructive form of hydrocephalus and/or early CSF circulation disturbances due to arachnoid villi malfunction. 1,5,15,19,20…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with the Need for Ventriculoperitoneal Shunting in Patients with Spontaneous Intracerebral Hemorrhage Requiring Emergency Cerebrospinal Fluid Diversion

Alimohammadi

Bagheri

Hadidi

et al. 2020

Indian Journal of Neurosurgery

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Introduction Intracerebral hemorrhage (ICH) is a serious medical condition that is frequently complicated by acute hydrocephalus, necessitating emergency cerebrospinal fluid (CSF) diversion in a subset of patients, ultimately requiring long-term treatment via placement of permanent ventricular shunts. The present study aimed to determine factors associated with the need for permanent ventricular shunt placement in these patients. Methods A total of 309 consecutive patients who underwent emergent CSF diversion with external ventricular drain (EVD) as a treatment for ICH between July 2009 and July 2018 were studied retrospectively to assess the factors that might be correlated with shunt-dependent chronic hydrocephalus. A binary logistic regression model was designed to identify independent related factors of shunt-dependent hydrocephalus after ICH. Results Of 309 patients included in this study, 102 (33.00%) required permanent ventricular CSF shunting before discharge. In univariate analysis, age,ventriculitis, ICP elevation >30 mm Hg, ICH evacuation, the Graeb score, days of EVD in place, and CSF protein levels were significantly associated with the requirement for permanent CSF diversion (p < 0.05). The age and ICH evacuation were protective variables and the ventriculoperitoneal (VP) shunt possibility was reduced by 22.6 and 63.5%, respectively. Conclusion Our results showed that higher Graeb score, ICP elevation >30 mm Hg, more days of EVD in place, and higher CSF protein levels were associated with permanent CSF diversion in these patients. Advanced age and ICH evacuation decreased the possibility of VP shunting in our study.These factors may help in predicting which patients will need permanent CSF diversion and could ultimately lead to improvements in the management of these patients.

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“…2,30 Hydrocephalus Requiring a Shunt Several earlier publications have shown that chronic post-aSAH hydrocephalus is related to significant morbidity and readmission to the hospital. 1,5,12,18,29,40 Potential reasons for an impaired outcome after the need for permanent cerebrospinal fluid diversion have been discussed in a recent publication and included elevated intracranial pressure, injury from catheter misplacement, rehemorrhage, and shunt infections. 10 According to our results, hydrocephalus requiring a shunt was a complication that was prominent among elder- 2) 38 (72 (<1) 14 (2) 9 (2) 89 (15) ly patients.…”

Section: Delayed Cerebral Vasospasm and Ischemiamentioning

confidence: 99%

Riskier-than-expected occlusive treatment of ruptured posterior communicating artery aneurysms: treatment and outcome of 620 consecutive patients

Huhtakangas¹,

Lehečka²,

Lehto³

et al. 2019

Journal of Neurosurgery

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OBJECTIVEOcclusive treatment of posterior communicating artery (PCoA) aneurysms has been seen as a fairly uncomplicated procedure. The objective here was to determine the radiological and clinical outcome of patients after PCoA aneurysm rupture and treatment and to evaluate the risk factors for impaired outcome.METHODSIn a retrospective clinical follow-up study, data were collected from 620 consecutive patients who had been treated for ruptured PCoA aneurysms at a single center between 1980 and 2014. The follow-up was a minimum of 1 year after treatment or until death.RESULTSOf the 620 patients, 83% were treated with microsurgical clipping, 8% with endovascular coiling, 2% with the two procedures combined, 1% with indirect surgical methods, and 6% with conservative methods. The most common procedural complications were treatment-related brain infarctions (15%). The occurrence of artery occlusions (10% microsurgical, 8% endovascular) was higher than expected. Most patients made a good recovery at 1 year after aneurysmal subarachnoid hemorrhage (modified Rankin Scale [mRS] score 0–2: 386 patients [62%]). A fairly small proportion of patients were left severely disabled (mRS score 4–5: 27 patients [4%]). Among all patients, 20% died during the 1st year. Independent risk factors for an unfavorable outcome, according to the multivariable analysis, were poor preoperative clinical condition, intracerebral or subdural hematoma due to aneurysm rupture, age over 65 years, artery occlusion on postoperative angiography, occlusive treatment–related ischemia, delayed cerebral vasospasm, and hydrocephalus requiring a shunt.CONCLUSIONSEven though most patients made a good recovery after PCoA aneurysm rupture and treatment during the 1st year, the occlusive treatment–related complications were higher than expected and caused morbidity even among initially good-grade patients. Occlusive treatment of ruptured PCoA aneurysms seems to be a high-risk procedure, even in a high-volume neurovascular center.

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Shunt-Dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage: Predictors and Long-Term Functional Outcomes

Abstract: aSAH patients with shunt-dependent hydrocephalus have significantly poorer long-term functional outcomes. Patients with risk factors for post-aSAH shunt dependence may benefit from increased surveillance, although the effect of such measures is not defined in this study.

Cited by 66 publications

References 22 publications

A scoring model to predict the prognosis of patients with poor-grade aneurysmal subarachnoid hemorrhage

A scoring model to predict the prognosis of patients with poor-grade aneurysmal subarachnoid hemorrhage

Factors Associated with the Need for Ventriculoperitoneal Shunting in Patients with Spontaneous Intracerebral Hemorrhage Requiring Emergency Cerebrospinal Fluid Diversion

Riskier-than-expected occlusive treatment of ruptured posterior communicating artery aneurysms: treatment and outcome of 620 consecutive patients

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