gms | German Medical Science

Objective: Shunt-dependent hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH). In addition, ventriculo-peritoneal shunt(VPS) placement in aSAH patients carries a certain risk of shunt dysfunction (VPSD). The objective of this study was to identify predictive factors leading to VPSD in aSAH patients.

Methods: This study was based on a single-center observational database containing all consecutive patients with aSAH admitted between January 1, 2005 and December 31, 2012.

The association between clinical and neuroimaging covariates and VPDS was first determined by univariate analysis. Covariates with P < 0.15 on univariate analysis were then analyzed in a multivariate logistic regression model. Receiver operating characteristic curve analysis was used to define optimal predictive thresholds.

Results: Overall, 16.8% (105/632) of patients required VPS insertion within the initial hospital stay. 23 patients (21.9%) underwent shunt revision due to VPSD in the later course. Multivariate analysis identified previous meningitis (odds ratio, 5.38; 95% confidence interval, 1.37- 14.28), higher CSF protein (odds ratio: 1.0013; 95% confidence interval, 1.001 -1.002), and Hunt and Hess Grade >3 (odds ratio, 0.304; 95% confidence interval, 0.082- 0.987) as independent VPSD predictors. Receiver operating characteristic curve analysis revealed that the preoperative CSF protein level threshold over 1400 mg/l was predictive to VPSD.

Conclusion: Initial severity of aSAH, development of meningitis, and high CSF protein levels seem to be the major risk factors for post-aSAH VPSD. CSF clearance from high protein levels prior to VPS placement may reduce the risk of VPDS. Shunt-dependent aSAH patients with the above-mentioned risk factors should undergo longer clinical surveillance due to the higher risk of VPSD.