Article
Risk of shunt-dependent hydrocephalus after occlusion of ruptured intracranial aneurysms by surgical clipping or endovascular coiling: a single institution series and meta-analysis
Häufigkeit von Shunt-pflichtigen Hydrozephalus nach Clipping und Coiling rupturierter Aneurysmen: Ergebnisse eines Zentrums und Metaanalyse
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Published: | April 11, 2007 |
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Objective: The aim of this study was to compare the risk for developing shunt-dependent hydrocephalus by clipping versus coiling of ruptured intracranial aneurysms.
Methods: We analyzed 596 patients prospectively added to our database form May 1999 to November 2005 concerning the risk of shunt dependency after clipping versus coiling. Factors analyzed included age, gender, H&H-grade and Fischer-grade, acute hydrocephalus, intraventricular hemorrhage (IVH), rebleeding, time to aneurysm obliteration, angiographic vasospasm (vs), days on ICU, aneurysm -number, -size and -location. In addition a meta analysis of available data form the literature was performed identifying 4 studies with quantitative data on the incidence of clip, coil and shunt dependency.
Results: The institutional series revealed H&H grade, Fisher-grade, acute hydrocephalus, IVH, rebleeding, angiographic vasospasm (day 7), time to treatment and days on ICU as significant (P<0.05) univariate risk factors for shunt dependency. In a multivariate logisitic regression analysis we could isolate IVH, acute hydrocephalus and angiographic vs as independent significant risk factors for shunt dependency. The meta analysis, including the current data, showed a significanly higher risk for shunt dependency after coling than clipping (P=0.01).
Conclusions: Clipping of a ruptured aneurysm may be associated with a lower risk for developing shunt dependency. This in turn may influence long-term outcome. It can be hypothesized that with surgical clipping the reason for a lower rate of shunt dependency is clot removal.