Article
Changes of ventricular width after external ventricular drainage and ventriculoperitoneal shunt predict shunt survival in patients with posthemorrhagic hydrocephalus after aneurysmatic subarachnoid hemorrhage
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Authors
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Johannes Lemcke
- Klinik für Neurochirurgie / Neurovaskuläres Zentrum, Unfallkrankenhaus Berlin, Berlin, Deutschland
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Christian von der Brelie
- Klinik für Neurochirurgie / Neurovaskuläres Zentrum, Unfallkrankenhaus Berlin, Berlin, Deutschland
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Alexander Gräwe
- Klinik für Neurochirurgie / Neurovaskuläres Zentrum, Unfallkrankenhaus Berlin, Berlin, Deutschland
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Ullrich Meier
- Klinik für Neurochirurgie / Neurovaskuläres Zentrum, Unfallkrankenhaus Berlin, Berlin, Deutschland
| Published: | June 2, 2015 |
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Outline
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Objective: The aim of the present study was to analyse the clinical outcome of patients with shunt dependent posthemorrhagic hydrocephalus (pHC) after aneurysmatic subarachnoid hemorrhage (SAH) with regard to the implanted valve type and the change of ventricular width after insertion of external ventricular drain respectively after shunt placement.
Method: From 2000 until 2013 547 patients with aneurysmatic SAH were treated at our institution, 114 of which underwent ventricular shunt placement. (21.1%). 47 patients with available pre- and postoperative CAT scans and an available follow-up of minimum six months were included. Ventricular width was analysed on CAT scans on different time points before and after surgical intervention. Initial equalized shunt survival (IESS) was analysed including surgical revisions for treatment of over- or underdrainage as well as re-programming of adjustable valve. Valve types were categorized in different subgroups.
Results: Different kinds of shunt valves were used. Twenty patients were treated with differential pressure valves of all kind, 15 patients were treated with flow regulated valves and 12 underwent VP shunt placement with differential pressure valves assisted by a gravitational unit. By trend, the flow regulated valve group showed the longer IESS but this was not statistically different. Patients who reacted with remarkable changes of the ventricular width after insertion of external ventricular drainage showed a longer IESS. Patients who reacted with smaller changes of the ventricular width after VP shunt placement showed a longer IESS.
Conclusions: Aneurysm associated pHC might be a heterogeneous entity. Decline of the ventricular width after EVD placement was a predictor for successful VP shunt therapy in the later course of disease. Possibly, this could allow to anticipatory identify patients who need specific valve types or valve settings and higher follow-up frequency. Bearing this in mind, valve type in pHC patients must be tested in a larger prospective randomized trial to identify which valve might be needed in which patient.
