gms | German Medical Science

Objective: In Western Europe an incidence rate of non traumatic subarachnoid-hemorrhage (SAH) has been documented as 7.12 per 100,000 individuals and is commonly encountered with neurological deterioration. Ventricular peritoneal Shunt placement (VPS) after non-traumatic subarachnoid hemorrhage (SAH) is an essential and common procedure for the treatment of post hemorrhagic hydrocephalus. Since several predisposing factors for the occurrence of VPS have been controversially discussed in the literature, we sought to determine in this study significant factors in this regard.

Methods: Between January 2005 and December 2010 all patient data diagnosed with spontaneous non-traumatic SAH upon admission were prospectively collected and retrospectively analyzed in our database at our department. At time of admission a detailed medical status was obtained and documented using the standard SAH scores. External ventricular drainage placement (EVD) was performed as part of the treatment plan in acute hydrocephalus and VPS shunting in chronic hydrocephalus, respectively. Data were statistically analyzed using t-test, Fisher exact test, and logistic regression analysis.

Results: In this study 389 consecutive patients, 257 female (66.2%) and 132 male (33.8%) with a median age of 54. In 91 patients (23%) a VP-shunt was implanted due to persistent post hemorrhagic hydrocephalus. All used scores (GCS, HH, WFNS and Fisher) were statistically significant considering the requirement of a VP shunt. In a second step we examined the association of factors influencing the risk of VPS using logistic regression analysis. Factors included median age, gender, GCS divided in 3 equally sized groups: GCS 3–7, GCS 8–14, and GCS 15, surgical interventions, coiling and/or clipping. In the full model, only GCS 8–14 vs. 3–7: p=0.016; 15 vs. 3–7: p=0.55 and coiling p=0.017 but not clipping p=0.16 were statistically significant. While the best fitting model took all four factors into account, only GCS (overall p=0.0063), coiling (p=0.034) and clipping (p=0.022) were statistically significant.

Conclusions: In this study we are able to show that patients with an initial GCS of 8 to 14 after aneurysm associated nontraumatic SAH had a 2.5 times higher risk of receiving a VPS than those with a GCS of 3 to 7. Therefore, this subgroup needs to be followed-up closely and VPS should be performed if clinical or radiological signs are present, especially after coiling.