Predicting factors for shunt-dependent hydrocephalus in patients with aneurysmal subarachnoid hemorrhage
- 177 Downloads
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.
KeywordsHydrocephalus Aneurysmal subarachnoid hemorrhage Fever Infection
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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).
For this type of study, formal consent is not required.
- 8.DeOliveira JG, Beck J, Setzer M, Gerlach R, Vatter H, Seifert V, Raabe A (2007) Risk of shunt-dependent hydrocephalus after occlusion of ruptured intracranial aneurysms by surgical clipping or endovascular coiling: a single-institution series and meta-analysis. Neurosurgery 61(5):924–933 discussion 933–934CrossRefGoogle Scholar
- 27.Paisan GM, Ding D, Starke RM, Crowley RW, Liu KC (2017) Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage: predictors and long-term functional outcomes. Neurosurgery. https://doi.org/10.1093/neuros/nyx393