Clinical Analysis of Risk Factors in Shunt-dependent Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage

Choe, Jong Won; Whang, Kum; Han, Yong Pyo; Kim, Hun Joo; Hu, Chul; Pyen, Jhin Soo; Jung, Hyun Ho; Park, Yong Sook

Abstract

OBJECTIVES
Shunt-dependent hydrocephalus is the major sequela after subarachnoid hemorrhage (SAH) and this continues to be a major source of morbidity for these patients. The prevalence and risk factors are not clear, despite the significant clinical and basic science research that's been done. We analyze the risk factors of shunt-dependent hydrocephalus such as the clinical and radiological parameters, the treatment modality and the peri-operative preparation.
METHODS
We collected data on 475 patients with aneurysmal SAH and who were admitted to our hospital between January 1996 and January 2005. We retrospectively analyzed the age, gender, Hunt-Hess grade, Fisher grade, hypertension, intraventricular hemorrhage (IVH), rebleeding, vasospasm, location of aneurysm, treatment modality, timing of surgery, lumbar drainage, external ventricular drainage (EVD) and the prognosis as risk factors.
RESULTS
22.1% (105/475) of the aneurysmal SAH patients developed shunt-dependent hydrocephalus. Univariate analysis revealed that the patient's age, Hunt Hess grade, IVH, rebleeding, vasospasm, location of aneurysm, timing of operation, lumbar drainage, EVD and the prognosis had statistically significant correlation with the development of shunt-dependent hydrocephalus (p<0.05). Through multivariate regression analysis, the aneurysms located in the posterior circulation, use of lumbar drainage and the cases with acute hydrocephalus showed a high prevalence of shunt-dependent hydrocephalus.
CONCLUSION
Among the numerous factors, only lumbar drainage was a partially controllable factor. Further analysis of the clinical factors associated with CSF drainage and re-evaluation of the indications for drainage are needed.