title: Hydrocephalus in 389 patients with aneurysm-associated subarachnoid hemorrhage.
abstract: Subarachnoid hemorrhage (SAH) often leads to hydrocephalus, which is commonly treated by placement of a ventriculoperitoneal (VP) shunt. There is controversy over which factors affect the need for such treatment. In this study, data were prospectively collected from 389 consecutive patients who presented with an aneurysm-associated SAH at a single center. External ventricular drainage placement was performed as part of the treatment for acute hydrocephalus, and VP shunts were placed in patients with chronic hydrocephalus. The data were retrospectively analyzed using two-sample t-tests, Fisher's exact test and logistic regression analysis. Overall, shunt dependency occurred in 91 of the 389 patients (23.4%). Using logistic regression analysis, two factors were found to be significantly associated with VP shunt placement: an initial Glasgow Coma Scale (GCS) score of 8-14 (8-14 versus 3-7, p = 0.016; 15 versus 3-7, p = 0.55); and aneurysm coiling (p = 0.017). Patients with an initial GCS score of 8-14 after aneurysm-associated SAH had a 2.5-fold higher risk of receiving a VP shunt than those with a GCS score of 3-7. Those with a GCS of 15 had a 50% lower risk of becoming shunt dependent than did the subgroup with a GCS score of 8-14. To clarify and strengthen these observations, prospective, randomized trials are needed.
authors.affiliation: Department of Neurosurgery, University Hospital of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland. c.woernle@gmail.com
authors.forename: Christoph M
authors.initials: CM
authors.lastname: Woernle
authors.forename: Kerstin M L
authors.initials: KM
authors.lastname: Winkler
authors.forename: Jan-Karl
authors.initials: JK
authors.lastname: Burkhardt
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Haile
authors.forename: David
authors.initials: D
authors.lastname: Bellut
authors.forename: Marian C
authors.initials: MC
authors.lastname: Neidert
authors.forename: Oliver
authors.initials: O
authors.lastname: Bozinov
authors.forename: Niklaus
authors.initials: N
authors.lastname: Krayenbühl
authors.forename: René-Ludwig
authors.initials: RL
authors.lastname: Bernays
mesh_terms: D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D017287:Ventriculoperitoneal Shunt / Q000379:methods*