Risk factors for shunt dependency in patients suffering from spontaneous, non-aneurysmal subarachnoid hemorrhage
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Patients presenting with spontaneous, non-aneurysmal subarachnoid hemorrhage (SAH) achieve better outcomes compared to patients with aneurysmal SAH. Nevertheless, some patients develop shunt-dependent hydrocephalus during treatment course. We therefore analyzed our neurovascular database to identify factors determining shunt dependency after non-aneurysmal SAH. From 2006 to 2016, 131 patients suffering from spontaneous, non-aneurysmal SAH were admitted to our department. Patients were stratified according to the distribution of cisternal blood into patients with perimesencephalic SAH (pSAH) versus non-perimesencephalic SAH (npSAH). Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months and stratified into favorable (mRS 0–2) versus unfavorable (mRS 3–6). A multivariate analysis was performed to identify predictors of shunt dependency in patients suffering from non-aneurysmal SAH. Overall, 18 of 131 patients suffering from non-aneurysmal SAH developed shunt dependency (14%). In detail, patients with npSAH developed significantly more often shunt dependency during treatment course, when compared to patients with pSAH (p = 0.02). Furthermore, patients with acute hydrocephalus, presence of intraventricular hemorrhage, presence of clinical vasospasm, and anticoagulation medication prior SAH developed significantly more often shunt dependency, when compared to patients without (p < 0.0001). However, “acute hydrocephalus” was the only significant and independent predictor for shunt dependency in all patients with non-aneurysmal SAH in the multivariate analysis (p < 0.0001). The present study identified acute hydrocephalus with the necessity of CSF diversion as significant and independent risk factor for the development of shunt dependency during treatment course in patients suffering from non-aneurysmal SAH.
KeywordsNon-aneurysmal subarachnoid hemorrhage Shunt dependency Perimesencephalic
Compliance with ethical standards
The present study was approved by the local ethics committee.
Informed consent was not sought as a retrospective study design was used.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Adams H, Ban VS, Leinonen V, Aoun SG, Huttunen J, Saavalainen T, Lindgren A, Frosen J, Fraunberg M, Koivisto T, Hernesniemi J, Welch BG, Jaaskelainen JE, Huttunen TJ (2016) Risk of shunting after aneurysmal subarachnoid hemorrhage: a collaborative study and initiation of a consortium. Stroke 47:2488–2496. https://doi.org/10.1161/STROKEAHA.116.013739 CrossRefPubMedGoogle Scholar
- 3.Boswell S, Thorell W, Gogela S, Lyden E, Surdell D (2013) Angiogram-negative subarachnoid hemorrhage: outcomes data and review of the literature. J Stroke Cerebrovasc Dis 22:750–757. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.02.001 CrossRefPubMedGoogle Scholar
- 4.de Oliveira JG, Beck J, Setzer M, Gerlach R, Vatter H, Seifert V, Raabe A (2007) Risk of shunt-dependent hydrocephalus after occlusion of ruptured intracranial aneurysms by surgical clipping or endovascular coiling: a single-institution series and meta-analysis. Neurosurgery 61:924–933; discussion 933–924. https://doi.org/10.1227/01.neu.0000303188.72425.24 CrossRefPubMedGoogle Scholar
- 5.Diesing D, Wolf S, Sommerfeld J, Sarrafzadeh A, Vajkoczy P, Dengler NF (2017) A novel score to predict shunt dependency after aneurysmal subarachnoid hemorrhage. J Neurosurg 1–7. doi: https://doi.org/10.3171/2016.12.JNS162400
- 8.Elhadi AM, Zabramski JM, Almefty KK, Mendes GA, Nakaji P, McDougall CG, Albuquerque FC, Preul MC, Spetzler RF (2015) Spontaneous subarachnoid hemorrhage of unknown origin: hospital course and long-term clinical and angiographic follow-up. J Neurosurg 122:663–670. https://doi.org/10.3171/2014.10.JNS14175 CrossRefPubMedGoogle Scholar
- 9.Gupta SK, Gupta R, Khosla VK, Mohindra S, Chhabra R, Khandelwal N, Gupta V, Mukherjee KK, Tewari MK, Pathak A, Mathuriya SN (2009) Nonaneurysmal nonperimesencephalic subarachnoid hemorrhage: is it a benign entity? Surg Neurol 71:566–571; discussion 571,571-562,572. https://doi.org/10.1016/j.surneu.2008.04.021 CrossRefPubMedGoogle Scholar
- 10.Jabbarli R, Bohrer AM, Pierscianek D, Muller D, Wrede KH, Dammann P, El Hindy N, Ozkan N, Sure U, Muller O (2016) The CHESS score: a simple tool for early prediction of shunt dependency after aneurysmal subarachnoid hemorrhage. Eur J Neurol 23:912–918. https://doi.org/10.1111/ene.12962 CrossRefPubMedGoogle Scholar
- 12.Konczalla J, Kashefiolasl S, Brawanski N, Lescher S, Senft C, Platz J, Seifert V (2016) Cerebral vasospasm and delayed cerebral infarctions in 225 patients with non-aneurysmal subarachnoid hemorrhage: the underestimated risk of Fisher 3 blood distribution. J Neurointerv Surg 8:1247–1252. https://doi.org/10.1136/neurintsurg-2015-012153 CrossRefGoogle Scholar
- 13.Konczalla J, Platz J, Schuss P, Vatter H, Seifert V, Güresir E (2014) Non-aneurysmal non-traumatic subarachnoid hemorrhage: patient characteristics, clinical outcome and prognostic factors based on a single-center experience in 125 patients. BMC Neurol 14:140. https://doi.org/10.1186/1471-2377-14-140 CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Konczalla J, Schmitz J, Kashefiolasl S, Senft C, Platz J, Seifert V (2016) Non-aneurysmal non-perimesencephalic subarachnoid hemorrhage: effect of rehabilitation at short-term and in a prospective study of long-term follow-up. Top Stroke Rehabil 23:261–268. https://doi.org/10.1080/10749357.2016.1149982 CrossRefPubMedGoogle Scholar
- 16.Raabe A, Beck J, Keller M, Vatter H, Zimmermann M, Seifert V (2005) Relative importance of hypertension compared with hypervolemia for increasing cerebral oxygenation in patients with cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 103:974–981. https://doi.org/10.3171/jns.2005.103.6.0974 CrossRefPubMedGoogle Scholar
- 20.Schuss P, Borger V, Güresir Á, Vatter H, Güresir E (2015) Cranioplasty and ventriculoperitoneal shunt placement after decompressive craniectomy: staged surgery is associated with fewer postoperative complications. World Neurosurg 84:1051–1054. https://doi.org/10.1016/j.wneu.2015.05.066 CrossRefPubMedGoogle Scholar
- 21.Schuss P, Wispel C, Borger V, Güresir Á, Vatter H, Güresir E (2017) Accuracy and safety of ventriculostomy using two different procedures of external ventricular drainage: a single-center series. J Neurol Surg Part A, Central Eur Neurosurg. https://doi.org/10.1055/s-0037-1606544
- 26.Wilson CD, Safavi-Abbasi S, Sun H, Kalani MY, Zhao YD, Levitt MR, Hanel RA, Sauvageau E, Mapstone TB, Albuquerque FC, McDougall CG, Nakaji P, Spetzler RF (2017) Meta-analysis and systematic review of risk factors for shunt dependency after aneurysmal subarachnoid hemorrhage. J Neurosurg 126:586–595. https://doi.org/10.3171/2015.11.JNS152094 CrossRefPubMedGoogle Scholar
- 27.Wilson DA, Nakaji P, Abla AA, Uschold TD, Fusco DJ, Oppenlander ME, Albuquerque FC, McDougall CG, Zabramski JM, Spetzler RF (2012) A simple and quantitative method to predict symptomatic vasospasm after subarachnoid hemorrhage based on computed tomography: beyond the Fisher scale. Neurosurgery 71:869–875. https://doi.org/10.1227/NEU.0b013e318267360f CrossRefPubMedGoogle Scholar