gms | German Medical Science

69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

Article

Send article

Gradual EVD weaning reduces the risk of shunt dependency after aneurysmal subarachnoid hemorrhage: a pooled analysis

Meeting Abstract

Search Medline for

  • Ramazan Jabbarli - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland; Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Daniela Pierscianek - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Marvin Darkwah Oppong - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Philipp Dammann - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Karsten H. Wrede - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Roland Rölz - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Mukesch Johannes Shah - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Josef Zentner - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocV082

doi: 10.3205/18dgnc083, urn:nbn:de:0183-18dgnc0838

Published: June 18, 2018

© 2018 Jabbarli 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: Chronic post-hemorrhagic hydrocephalus necessitating shunt placement is a common complication of subarachnoid hemorrhage (SAH). We aimed at evaluating the role of external ventricular drainage (EVD) weaning on the risk of shunt dependency after SAH.

Methods: Two German university hospitals with different EVD management regimes (rapid [RW] vs gradual weaning [GW]) pooled the data of their observational cohorts containing altogether 1171 consecutive SAH patients treated between January 2005 and December 2012. Development and timing of shunt dependency in SAH survivals were the endpoints of the study.

Results: The final cohort consisted of 455 and 510 SAH survivors treated in the centers with RW and GW respectively. Mortality rates, as well as baseline demographic, clinical and radiographic parameters showed no differences between the centers. Patients with GW were less likely to develop shunt dependency (27.5% vs 34.7%, p=0.0176), Multivariate analysis confirmed independent association between RW regime and shunt dependency (p=0.026). Shunt-dependent SAH patients undergoing GW required significantly longer weaning phase (mean 29.8 vs 21.7 days, p<0.0001) and hospital stay (mean 39 vs 34.4 days, p=0.0304). In addition, patients with GW were at higher risk for secondary shunt placement after successful initial weaning (p=0.0006). The risk of CSF infection was not associated with the weaning regime (15.3% vs 12.9%, p=0.3068).

Conclusion: At the expense of longer treatment, GW may decrease the risk of shunt dependency after SAH without an additional risk for infections. Due to the risk of delayed shunt dependency, SAH patients with GW require proper post-hospital neurological care.