gms | German Medical Science

Objective: Subarachnoid hemorrhage (SAH) is often associated with chronic hydrocephalus, which has to be treated by ventriculoperitoneal shunting (VPS). Our objective was to identify risk factors for chronic hydrocephalus in a current patient cohort and to compare the incidence of hydrocephalus and rate of VPS with a historical cohort.

Method: Patients suffering from aneurysmal SAH from Nov 2010 – Nov 2013 were prospectively enrolled and analyzed in this study. Data were screened for age, gender, initial Glasgow Coma Scale (GCS), Hunt&Hess (H&H) grade, Fisher grade, incidence of acute hydrocephalus with external ventricular drainage (EVD), localization and diameter of aneurysm, treatment of aneurysm with coiling/clipping, incidence of ventriculitis/meningitis (V/M), outcome at discharge using Glasgow Outcome Scale (GOS) and length of hospital stay. Data was statistically examined using t-test, Fisher exact test and CART- (Classification and Regression Trees) analysis. The Chi squared test was used to compare the present cohort with a historic SAH-patient group (1981-1997) regarding the incidence of EVD and VPS.

Results: 189 patients in total, 131 female (69.3%) and 58 male (30.7%) with a mean age of 53.9 ± 13.8 years were enrolled. VPS was necessary in 29 patients (15.3%). H&H grade (p < 0.001), placement of EVD (p = 0.001) and occurrence of V/M (p < 0.001) correlated statistically significant with the placement of VPS. All other factors had no statistical impact. CART-analysis showed that patients with V/M and H&H grade > 2 have a 48.2% chance requiring VPS. Patients with VPS had a significantly worse outcome at discharge (p = 0.02) and a longer hospital stay (p < 0.001). An institutional retrospective SAH-group had a lower rate of VPS (134 out of 1386 patients, 9.6%; p = 0.02) and they also received an EVD (p < 0.001) less frequently.

Conclusions: Almost 50% of the SAH-patients admitted with H&H grade higher than 2 and with ventriculitis/meningitis require VPS in which the acute hydrocephalus with the need for EVD is a predeterminating factor for VPS. Changes in the postoperative management, e.g. lumbar drainages are less commonly used in the postoperative management today. This may explain a significantly higher rate of VPS in the present group. In regard to a 5-10% higher shunting rate and its associated complications, perioperative management has to be reviewed once again very carefully.