gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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Predicitive factors for shunt-dependency in patients with acute malresorptive hydrocephalus after aneurysmal subarachnoid hemorrhage

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  • K. Harmening - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München
  • M. Wostrack - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München
  • F. Dorn - Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität München
  • Y.M. Ryang - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München
  • B. Meyer - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München
  • M. Stoffel - Neurochirurgische Klinik, Klinikum rechts der Isar, Technische Universität München

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.08.03

doi: 10.3205/12dgnc228, urn:nbn:de:0183-12dgnc2288

Published: June 4, 2012

© 2012 Harmening et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: A common sequel after aneurysmal subarachnoid hemorrhage (SAH) is hydrocephalus (HC) malresorptivus. Although the rate of patients with acute HC requiring external ventricular drainage (EVD) is quite high, only some of them develop a shunt-dependent HC after SAH. The aim of this study was to determine predictive factors for shunt dependency after aneurysmal SAH.

Methods: Retrospective analysis of a prospective database of 313 consecutive patients with acute aneurysmal SAH treated between March 2006 and December 2010 at our department who survived at least until the aneurysm treatment was performed. 61% (n = 190) required an EVD due to the acute HC. 17% (n = 32) of the patients with acute HC died during the same hospitalization. 33% (n = 52) of 158 surviving patients underwent shunt surgery due to posthemorrhagic HC. The following potentially predictive factors were analysed: gender, age, treatment modality (coiling/ clipping), Hunt and Hess grade, Fisher grade, presence of an intraventricular hemorrhage (IVH), meningitis during the hospitalization, location, and size of the aneurysm.

Results: Univariate logistic regression model revealed that Fisher grade (p = 0,029), presence of IVH (p = 0,017), and meningitis (p = 0,003) are highly associated with shunt dependency. Multivariate logistic regression analysis assessed only the presence of IVH (p = 0,021) and meningitis (p = 0,004) as independent predictors.

Conclusions: The presence of an IVH on the initial CT scan and meningitis during the hospitalization represented independent predictors for the development of shunt-dependent posthemorrhagic HC. The association between endovascular treatment and a higher risk for shunt-dependency frequently discussed in previous studies was not observed in our multivariate analysis.