Risk of shunt-dependent hydrocephalus after occlusion of ruptured intracranial aneurysms by surgical clipping or endovascular coiling: a single-institution series and meta-analysis.
OBJECTIVE
To compare the risk of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by clipping versus coiling.


METHODS
We analyzed 596 patients prospectively added to our database from July of 1999 to November of 2005 concerning the risk of shunt dependency after clipping versus coiling. Factors analyzed included age; sex; Hunt and Hess grade; Fisher grade; acute hydrocephalus; intraventricular hemorrhage; angiographic vasospasm; and number, size, and location of aneurysms. In addition, a meta-analysis of available data from the literature was performed identifying four studies with quantitative data on the frequency of clip, coil, and shunt dependency.


RESULTS
The institutional series revealed Hunt and Hess grade, Fisher grade, acute hydrocephalus, intraventricular hemorrhage, and angiographic vasospasm as significant (P < 0.05) risk factors for shunt dependency after a univariate analysis. In a multivariate logistic regression analysis, we isolated intraventricular hemorrhage, acute hydrocephalus, and angiographic vasospasm as independent, significant risk factors for shunt dependency. The meta-analysis, including the current data, revealed a significantly higher risk for shunt dependency after coiling than after clipping (P = 0.01).


CONCLUSIONS
Clipping of a ruptured aneurysm may be associated with a lower risk for developing shunt dependency, possibly by clot removal. This might influence long-term outcome and surgical decision making.
de Oliveira
Jean G
JG
Department of Neurosurgery, Neurocenter, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. jeangol@uol.com.br
Beck
Jürgen
J
Setzer
Matthias
M
Gerlach
Rüdiger
R
Vatter
Hartmut
H
Seifert
Volker
V
Raabe
Andreas
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000453:epidemiology* / Q000628:therapy*; D002557:Cerebrospinal Fluid Shunts / Q000706:statistics & numerical data*; D015897:Comorbidity; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology* / Q000517:prevention & control; D015994:Incidence; D002532:Intracranial Aneurysm / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*