gms | German Medical Science

Objective: Hydrocephalus is a well-known consequence of aneurysmal subarachnoid hemorrhage (aSAH). In daily routine it is difficult, however, to predict whether a patient will need a shunt in the course of the disease. The purpose of this study was to identify volumetric radiological predictors of development of a shunt-dependent hydrocephalus after aSAH.

Method: A cohort of 217 patients who were treated for aneurysmal subarachnoid hemorrhage from January 2009 to June 2015 at our institution and had an initial CT scan available was retrospectively reviewed. All variables, including demographic data, treatment and initial CT imaging were gathered and grading was performed using Hunt & Hess, Graeb, LeRoux and mFisher scores. Analysis of the radiographic parameters was done by straight measurement and 3D-volumetry using a segmentation algorithm. Univariate and multivariate analyses were performed to identify predictive parameters.

Results: 36 patients (17.5%) required a ventriculoperitoneal shunt (VPS) in our series. Higher age, blood in the fourth ventricle on admission, bifrontal ventricular diameter on admission, diameter and volume of the third ventricle and need for EVD placement prior to intervention were significantly (p < 0.05) associated with shunt-dependency in univariate analysis. The treatment modality was not statistically associated with the need for VPS after aSAH, as well as all the scores. In multivariate analysis, only the 3D-volume of the third ventricle as well as the presence of blood in the fourth ventricle remained a significant prognostic marker for the need of a VPS.

Conclusions: Our data suggest that the volume of the third ventricle on the initial CT is a significant predictor for shunt dependency after aSAH. The absolute amount of blood showed no relevant effect in our study.