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66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Pending variables for shunt dependency in non-traumatic SAH: a retrospective analysis of 324 patients

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  • Anna-Margarete Bohrer - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Daniela Pierscianek - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Daniela Müller - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Ramazan Jabbarli - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Ulrich Sure - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Oliver Müller - Klinik für Neurochirurgie, Universitätsklinikum Essen

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocMO.02.05

doi: 10.3205/15dgnc011, urn:nbn:de:0183-15dgnc0110

Published: June 2, 2015

© 2015 Bohrer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: To assess the incidence of hydrocephalic shunt dependency in patients suffering from non-traumatic subarachnoid hemorrhage (SAH) and to identify pending variables to predict the need for ventricular shunting.

Method: A total of 324 patients suffering from SAH were included for study purposes during a period from 01/2008 to 12/2013. Of 273 patients (84,3%) who survived the initial hemorrhage, 97 (29,9%) needed shunting. Pre-/post-therapeutic CT scans were evaluated for SAH, intraventricular (IVH), intracerebral hemorrhage (ICH), and infarctions. Correlations were calculated for Hunt & Hess (H&H) and Fisher score, sex, age, aneurysm treatment modality, location and number of aneurysm(s), initial hydrocephalus, vasospasms and meningitis. Clinical outcome at discharge and at follow-up was assessed from medical records using Glasgow Outcome Scale (GOS).

Results: In this cohort of shunt patients after SAH, 39 patients were clipped and 47 patients underwent coil embolization, 5 patients needed both treatment modalities. No vascular lesion was detected in 6 patients. Good H&H scores were a negative predictor for shunt dependency. A strong correlation was found with Fisher score 4 (p < 0.001), IVH (p < 0.05) and initial hydrocephalus (p < 0.05). Vasospasms frequently preceded shunting (p < 0.05). Shunt dependency was a negative predictor for a good clinical outcome (GOS 4-5; p < 0.05). Ruptured aneurysms of the anterior circulation were related with a higher rate of shunt dependency (p < 0.001). Although, intercurrent meningitis was significantly associated with shunt dependency, in multiple regression analysis, meningitis itself did not account for the main reason of shunt dependency. Yet, meningitis was a negative predictor for a good clinical outcome. Treatment modality did not influence shunt dependency. All other analyzed variables were not correlated with the need for shunting.

Conclusions: From our data we suggest a number of pending variables as listed above that predict shunt dependency after SAH. These may help the treating physician with the decision for early shunt placement rather than prolonged external drainage either by ventricular or lumbar drain to further reduce the rate of catheter-associated meningitis.