Factors Related to Shunt-Dependent Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage

Park, Hyeon; Kang, Dong Ho; Lee, Chul Hee; Hwang, Soo Hyun; Jung, Jin Myung; Han, Jong Woo; Park, In Sung

Abstract

OBJECTIVE
The purpose of this study is to investigate various factors predictive of shunt-dependent hydrocephalus among patients with aneurysmal subarachnoid hemorrhage.
METHODS
One hundred fifty three patients with aneurysmal subarachnoid hemorrhage who were treated between 2001 and 2003 were retrospectively studied to identify factors contributing to shunt-dependent hydrocephalus. Overall, 27 of the 153 patients (17.6%) underwent shunt operation for treatment of hydrocephalus. Mean age and mean follow-up duration of the patients were 55 years and 18.9 months respectively. Univariate analysis was performed to assess relationships among various factors and hydrocephalus. Factors statistically associated with the occurrence of hydrocephalus were analyzed using logistic regression analysis.
RESULTS
Of the factors investigated, the followings were related to shunt-dependent hydrocephalus, as determined with a variety of statistical METHODS: 1) increasing age (p<0.001), 2) premorbid hypertension (p<0.05), 3) poor admission Hunt and Hess grade (p<0.001), 4) thick subarachnoid hemorrhage on admission computed tomographic scans (p<0.001), 5) acute hydrocephalus (p<0.05), 6) rebleeding (p<0.05), 7) intraventricular hemorrhage (p<0.05), and 8) long duration of external ventricular drainage (p=0.001). Sex, location of aneurysms, vasospasm, or the presence of intracerebral hemorrhage, Sylvian hematoma, and subdural hematoma did not influence the development of shunt-dependent hydrocephalus. Logistic regression analysis of clinical factors revealed that age and vasospasm are related to shunt-dependent hydrocephalus.
CONCLUSION
Hydrocephalus seems to be associated with multifactorial etiology. Knowledge of risk factors related to the development of hydrocephalus may help neurosurgeons in terms of the long-term care of patients who have experienced aneurysmal subarachnoid hemorrhage.