Prediction of shunt dependent hydrocephalus following aneurysmal subarachnoid hemorrhage “algorithm based management”

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Prediction of shunt dependent hydrocephalus following aneurysmal subarachnoid hemorrhage “algorithm based management”

Journal Title: Nepal Journal of Neuroscience - Year 2018, Vol 15, Issue 2

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating disease with a high rate of mortality and permanent morbidity. An important neurologic complication is hydrocephalus reported to range from 6 to 67% while only 10-20% of them will require permanent CSF diversion.The purpose of this study was to identify predictive factors for the development of shunt dependant hydrocephalus among patients with aSAH. This is a retrospective study conducted in among 72 patients who underwent clipping of aneurysm for subarachnoid hemorrhage in our institute during 2 years. EVD placement done for acute hydrocephalus while VP shunt was done for chronic hydrocephalus or requiring prolonged EVD placement. Various clinical and radiological factors were registered on admission and during the intensive care stay. Multivariate logistic regression analysis was done to predict risk of shunt dependant hydrocephalus. P value less than 0.05 was considered signifi cant. Among 72 patients with aSAH. Intraventricular extension of blood was seen in 24 (33.3%) patients while hydrocephalus was seen among 19 (26.4%) patients. Eight patients (11.1%) required EVD placement for acute hydrocephalus while 10 (13.9%) patients required permanent shunt placement for chronic hydrocephalus. In univariate analysis, SAH with fi sher grade >2, presence of hydrocephalus, intraventricular extension of hemorrhage and need of EVD placement were found to have signifi cant association in shunt dependency. However multivariate logistic regression model showed EVD requirement for acute hydrocephalus as an independent predictor of To access Nepal Journal of Neuroscience, Archives scan QR code: How to Cite Shrestha, S., Bishokarma, S., Lohani, S., Sapkota, S., Thapa, S., & Gongal, D. N. (2018). Prediction of shunt dependent hydrocephalus following aneurysmal subarachnoid hemorrhage “algorithm based management”. Nepal Journal of Neuroscience, 15(3), 21-26. https://doi.org/10.3126/njn.v15i3.23272 22 Nepal Journal of Neuroscience, Volume 15, Number 3, 2018 Hydrocephalus is a common complication following aneurysmal subarachnoid hemorrhage (aSAH) reported to range from 6 to 67%.1 Acute hydrocephalus requiring a temporary external CSF diversion occurs in 15%–87% of aSAHwhile permanent CSF diversion is required among 6 to 37% requires shunt.2,3Advanced age, poor clinical status, aneurysm location, especially in the posterior circulation, initial mental status, and presence of initial intraventricular hemorrhage (IVH), acute hydrocephalus are risk factors for development of SDH.4-10 The purpose of this study was to identify predictive factors for the development of SDH among patients with SAH. Methods: This is a retrospective study conducted in Upendra Devkota Memorial National Institute of Neurological and Allied Sciences (UDM-NINAS), Bansbari, Kathmandu, Nepal among patients who underwent clipping of ruptured aneurysm during two years period. Surgically clipped aneurysm patients who survived for at least three months were included. Those who died early, were lost to follow up or denied further treatment were excluded. Ethical clearance was taken from the Institutional Review Board at UDM-NINAS. All patients were treated according to the standardized protocol, which closely follows international guidelines.11,12Patient were monitored in ICU and serial CT scan was done. Evan’s ratio >0.3 is considered hydrocephalus and those requiring CSF diversion were managed with external ventricular drainage (EVD). Clipping of aneurysm was done with standard pterional approach. Post operatively patients were managed in Intensive Care Unit (ICU) with triple H therapy including Nimodipine and adequate hydration to maintain central venous pressure (CVP) around 12 mm Hg. Post-operative shunt dependent hydrocephalus at p value 0.006 (OR=21.3; 95% CI=2.38 to 191.51). Hydrocephalus is a common complication following aneurysmal subarachnoid hemorrhage. SAH with fi sher grade >2, presence of hydrocephalus, intraventricular extension of hemorrhage and need of EVD placement were found to have signifi cant association in shunt dependency however only EVD requirement is an independent predictor of SDH.

Authors and Affiliations

Dr. Shikher Shrestha

Keywords

aneurysm external ventricular drainage hydrocephalus intraventricular extension subarachnoid hemorrhage ventriculoperitoneal shunt WFNS.

EP ID EP558844
DOI -
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