WITHDRAWN: Shunt-Dependent Hydrocephalus After Aneurysm Subarachnoid Hemorrhage: Predictors and its Relationship with Lumbar Puncture

Abstract

Objective To identify predictors of shunt-dependent hydrocephalus (SDHC) after aneurysmal subarachnoid hemorrhage (aSAH) and determine the effect of postoperative lumbar puncture (LP) on the incidence of SDHC. Methods We conducted a retrospective review of consecutive patients with aSAH who underwent surgical clipping or endovascular embolization for cerebral aneurysm in our hospital from October 2009 to May 2019. Univariate and multivariate analyses were performed to characterize risk factors for SDHC after aSAH. The incidence of SDHC in the LP and No LP groups were compared after propensity score matching analysis. Results A total of 414 patients were enrolled in this study. SDHC developed in 59 patients (14.3%). On multivariate analysis, age > 55 years (P = 0.004), intraventricular hemorrhage (IVH) (P = 0.038), Fisher grade ≥ 3 (P = 0.043), Hunt and Hess grade (H&H) ≥ 3 (P = 0.027), acute hydrocephalus (P = 0.001), central nervous system infection (CNSI) (P = 0.021), placement of external ventricular drainage (EVD) (P = 0.044), and a history of postoperative LP (P < 0.016) were independently associated with SDHC after aSAH. Propensity score matched cohorts exhibited a significantly higher incidence of SDHC after LP treatment than that without LP (20.7% vs 12.1%, P = 0.019). Receiver operating characteristic analysis revealed an area under the curve of 0.818 for the final regression model. Conclusion Evaluating risk factors can help identify patients at high risk of developing SDHC. Postoperative LP may increase the incidence of SDHC after aSAH. Strategies for treatment of ruptured aneurysms should be used to mitigate SDHC and minimize poor outcomes.