gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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IVH Score for the prediction of shunt dependency in patients suffering from aneurysmal subarachnoid hemorrhage with intraventricular hemorrhage

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  • Bogdan Iliev - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Turab Gasimov - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
  • Vesna Malinova - Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 047

doi: 10.3205/17dgnc610, urn:nbn:de:0183-17dgnc6103

Published: June 9, 2017

© 2017 Iliev 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

Text

Objective: The presence of intraventricular hemorrhage (IVH) is a known risk factor for the development of hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH). The amount of intraventricular blood and the location within the third and fourth ventricles correlate with higher incidence of hydrocephalus and shunt dependency. A simple scoring system allowing an early identification of patients, who will need a ventriculoperitoneal (VP)-shunt is currently lacking. We evaluated the validity of a simple IVH score for the prediction of shunt dependency after aSAH.

Methods: Patients with aSAH admitted to our clinic from January 2012 to September 2016 were retrospectively analyzed for the need of VP-shunt placement. The volume of the intraventricular clot in every ventricle was estimated based on the initial CT scan. A blood volume filling more than 50% of the ventricle volume was considered significant. The following scoring system (range 0-8) was defined for the classification of the IVH extension: for every lateral ventricle 1 point and for the third and fourth ventricles 3 points were given, respectively. The predictive value of the IVH score for shunt dependency was assessed using the Fisher’s exact test.

Results: A total of 191 patients were analyzed. The mean age was 55 years, 67% (128/191) were female and 33% (63/191) male. In 25% (47/191) a VP-shunt was implanted. In the patients with a VP-shunt a mean IVH score of 4.8 was found, while the patients without VP-shunt had a mean score of 1.6. Patients with a score ≥4 have a significantly higher risk to become shunt dependent compared to the patients with a score <4 (OR 6.9 95% CI 3.2-14.5; p<0.0001). A score ≥4 showed a high specificity of 84% with a sensitivity of 58%; the positive predictive value was 52% (95% CI 39-65%) and the negative predictive value was 87% (95% CI 80-91%).

Conclusion: The IVH score is a simple score allowing the identification of patients who are at higher risk to develop chronic hydrocephalus with the need of VP-shunt after aSAH with IVH. A more aggressive management with intraventricular thrombolysis should be considered in patients with high IVH-Score.