Early ventriculoperitoneal shunt placement after severe aneurysmal subarachnoid hemorrhage: role of intraventricular hemorrhage and shunt function.
OBJECTIVE
This study investigated the outcome of early shunt placement in patients with poor-grade subarachnoid hemorrhage and the effect of intraventricular hemorrhage (IVH) and high proteinaceous cerebrospinal fluid (CSF) on subsequent shunt performance.


METHODS
This study included 33 consecutive patients with initial Fisher grade (3/4) subarachnoid hemorrhage who had undergone conversion from external ventricular drainage (EVD) to a ventriculoperitoneal (VP) shunt and whose computed tomography scan showed IVH at the time of shunt placement. Early weaning from an EVD and conversion to a VP shunt was performed irrespective of IVH or high protein content in the CSF.


RESULTS
The mean interval from EVD to VP shunt placement was 6.4 days. The mean volume of IVH was 9.44 mL, and the mean value of IVH/whole ventricle volume ratio (ie, percentage of blood suspension in the CSF) was 9.81%. The mean perioperative protein level in the CSF was 149 mg/dL. During the follow-up period, 2 patients (6.1%) required VP shunt placement, and no patients experienced complications of ventriculitis or shunt-related infection.


CONCLUSIONS
Based on our data, earlier EVD weaning and shunt placement can effectively treat subarachnoid hemorrhage-induced hydrocephalus in patients with severe subarachnoid hemorrhage. This procedure resulted in no shunt-related infections and a 6.1% revision rate. There were fewer adverse effects of IVH and protein on shunt performance. Therefore, weaning from an EVD and conversion to a permanent VP shunt need not be delayed because of IVH or proteinaceous CSF.
Kang
Dong-Hun
DH
Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea 700-721.
Park
Jaechan
J
Park
Seong-Hyun
SH
Kim
Yong-Sun
YS
Hwang
Sung-Kyoo
SK
Hamm
In-Suk
IS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000134:cerebrospinal fluid / Q000209:etiology / Q000601:surgery; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D004322:Drainage; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid / Q000150:complications / Q000601:surgery*; D020542:Third Ventricle / Q000473:pathology; D017287:Ventriculoperitoneal Shunt
D002556:Cerebrospinal Fluid Proteins