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Acta Neurochirurgica

, Volume 156, Issue 11, pp 2059–2069 | Cite as

Predictors of shunt dependency after aneurysmal subarachnoid hemorrhage: results of a single-center clinical trial

  • Hampus Olof Erixon
  • Angelika Sorteberg
  • Wilhelm Sorteberg
  • Per Kristian EideEmail author
Clinical Article - Vascular

Abstract

Background

Hydrocephalus (HC) after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequel. Proper selection of patients in need of permanent cerebrospinal fluid (CSF) diversion is, however, not straightforward. The aim of this study was to identify predictors of CSF shunt dependency following aSAH.

Methods

We re-analyzed data acquired from aSAH patients previously enrolled in a prospective, controlled single-center clinical trial in which shunt dependency was not one of the end points. In the present study patients were allocated into two groups: those receiving a shunt (here denoted as shunt dependent) and those not receiving a shunt, based on a clinical decision process. Predictors of shunt dependency were identified by applying uni- and multivariable analysis. We tested a set of predefined possible risk factors based on the results of the clinical trial, including the impact of CSF drainage volume exceeding 1,500 ml during the 1st week after ictus.

Results

Ninety patients were included in the study. Significant predictors of shunt dependency were poor clinical grade at admission [odds ratio (OR) 4.7, 95 % confidence interval (CI) 1.2–18.4], large amounts of subarachnoid blood (OR 3.8, 95 % CI 1.0–14.0), large ventricular size on preoperative cerebral computer tomographic (CT) scans (OR 1.0, 95 % CI 1.0–1.1), and CSF volume drainage exceeding 1,500 ml during the 1st week after the ictus (OR 16.3, 95 % CI 4.0–67.1). Age ≥70 years, larger amounts of intraventricular blood, vertebrobasilar aneurysm, and endovascular treatment tended to increase the likelihood of receiving a shunt. Outcome was not significantly different between shunted and non-shunted patients.

Conclusions

In this cohort of patients with clinical grade aSAH at admission, larger amounts of subarachnoid blood and large ventricular size on preoperative cerebral CT, and CSF drainage in excess of 1,500 ml during the 1st week after the ictus were significant predictors of shunt dependency. Shunt dependency did not hamper outcome.

Keywords

Subarachnoid hemorrhage Hydrocephalus Shunt dependency Outcome 

Notes

Acknowledgments

The authors thank Dr. Are Hugo Pripp, Biostatistics Unit, Oslo University Hospital, Rikshospitalet, Oslo, for statistical help during preparation of the article.

Conflicts of interest

None.

Funding/financial support

Faculty of Medicine, University of Oslo, Oslo, Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway.

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Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Hampus Olof Erixon
    • 2
  • Angelika Sorteberg
    • 1
  • Wilhelm Sorteberg
    • 1
  • Per Kristian Eide
    • 1
    • 2
    Email author
  1. 1.Department of NeurosurgeryOslo University Hospital-RikshospitaletOsloNorway
  2. 2.Faculty of MedicineUniversity of OsloOsloNorway

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