Acta Neurochirurgica

, Volume 160, Issue 7, pp 1407–1413 | Cite as

Predicting factors for shunt-dependent hydrocephalus in patients with aneurysmal subarachnoid hemorrhage

  • Yung Ki Park
  • Hyeong-Joong Yi
  • Kyu-Sun Choi
  • Young-Jun Lee
  • Hyoung-Joon Chun
  • Sae Min Kwon
  • Dong-Won Kim
Original Article - Vascular Neurosurgery - Aneurysm



Chronic hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH) is a major complication that leads to a medical burden and poor clinical outcomes. The aim of this study was to evaluate the predictive factors of shunt-dependent hydrocephalus focusing on postoperative fever and infection.


A total of 418 patients were included in this study and the patient demographic features, radiologic findings, days of fever burden, and infection were compared between the shunt (n = 72) and no shunt group (n = 346). Days of fever burden was defined as the total number of days with the highest body temperature ≥ 38.0 °C each day from day 1 to day 14. Pneumonia, urinary tract infection (UTI), meningitis, and bacteremia were recorded in all patients.


The independent predictive factors for shunt-dependent hydrocephalus were older age ≥ 65, microsurgical clipping, placement of extraventricular drainage (EVD), days of fever burden, and infection. The incidence of shunt dependency was 2.4% in the no fever burden patients (n = 123), 14.9% in the 1–3 days of fever burden patients (n = 161), 27.0% in the 4–6 days of fever burden patients (n = 74), and 41.7% in the ≥ 7 days of fever burden patients with statistical significance among groups (p < 0.001).


The rate of shunt dependency increased proportionally as the days of fever burden increased. Older age (≥ 65), microsurgical clipping, placement of EVD, days of fever burden, and infection were independent predictive factors for shunt dependency. Proper postoperative care for maintaining normal body temperature and preventing infectious disease can help reduce the rate of shunt dependency and improve clinical outcomes.


Hydrocephalus Aneurysmal subarachnoid hemorrhage Fever Infection 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the institutional review board at the author’s institute (HYUH IRB 2017-10-008-001).

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Yung Ki Park
    • 1
  • Hyeong-Joong Yi
    • 1
  • Kyu-Sun Choi
    • 1
  • Young-Jun Lee
    • 2
  • Hyoung-Joon Chun
    • 1
  • Sae Min Kwon
    • 1
  • Dong-Won Kim
    • 3
  1. 1.Department of NeurosurgeryHanyang University Medical CenterSeoulSouth Korea
  2. 2.Department of RadiologyHanyang University Medical CenterSeoulSouth Korea
  3. 3.Department of Anesthesiology and Pain MedicineHanyang University Medical CenterSeoulSouth Korea

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