Turkish Neurosurgery
Factors related to the development of shunt-dependent hydrocephalus following subarachnoid hemorrhage in the elderly
Tae Seok Jeong1, Chan Jong Yoo1, Woo Kyung Kim1, Gi Taek Yee1, Eun Young Kim1, Myeong Jin Kim1
1Gachon Gil Medical Center, Neurosurgery, Incheon,
DOI: 10.5137/1019-5149.JTN.19752-16.1

Aim:Surgical procedures for aneurysmal subarachnoid hemorrhage (SAH) are increasing among the elderly as the population ages. Chronic shunt-dependent hydrocephalus is a recognized complication of SAH. The purpose of this study was to identify factors predictive of the development of shunt-dependent hydrocephalus among elderly patients with SAH.Material and Methods:We retrospectively studied 878 patients, including 275 patients ≥ 65 years old, with SAH treated between 2005 and 2015 to identify factors contributing to the development of shunt-dependent hydrocephalus. The relationships between shunt-dependent hydrocephalus and the causative factors were analyzed using univariate and multivariate analysis; the causative factors studied were based on the results of previous studies.Results:In the 878 patients with SAH, there was a significant difference in the incidence of shunt-dependent hydrocephalus between patients < 65 years old and those ≥ 65 years old (p=0.021). In the 275 patients ≥ 65 years old, the following were associated with shunt-dependent hydrocephalus on univariate analysis: 1) Hunt and Hess grade (p=0.005), 2) Fisher grade (p<0.001), 3) intraventricular hemorrhage (p<0.001), 4) acute hydrocephalus (p=0.003), 5) aneurysm location (p=0.001), and 6) external ventricular drain placement (p<0.001). On multivariate analysis, only 1) intraventricular hemorrhage (p<0.001) and 2) a ruptured aneurysm located in the distal posterior circulation (p=0.014) were related to an increased risk for the development of shunt-dependent hydrocephalus.Conclusion:Evaluating risk factors can help identify patients at high risk of developing shunt-dependent hydrocephalus. Identifying these risk factors may help neurosurgeons provide optimal therapy and improve outcomes in patients with SAH.