Turkish Neurosurgery 2018 , Vol 28 , Num 1
The Clinical Predictors of Shunt-Dependent Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage
Sio Iong CHANG1,2,Ming Dar TSAI3,5,David Hung-Tsang YEN1,4,Cheng-Ta HSIEH5,6
1National Yang-Ming University, College of Medicine, Institute of Emergency and Critical Care Medicine, Taipei, Taiwan
2Yonghe Cardinal Tien Hospital, Department of Neurosurgery, New Taipei City, Taiwan
3Shin Kong Wu-Ho-Su Memorial Hospital, Department of Neurosurgery, Taipei, Taiwan
4Taipei Veterans General Hospital, Department of Emergency Medicine, Taipei, Taiwan
5Fu-Jen Catholic University, School of Medicine, New Taipei City, Taiwan
6Cathay General Hospital, Department of Surgery, Division of Neurosurgery, Taipei, Taiwan
DOI : 10.5137/1019-5149.JTN.18752-16.1 AIM: Shunt-dependent hydrocephalus (SDH) is a relatively common complication following aneurysmal subarachnoid hemorrhage (aSAH). Delay in diagnosis and treatment may worsen neurological outcome. This study was conducted to identify early clinical factors associated with SDH following aSAH.

MATERIAL and METHODS: Patients diagnosed with aSAH at our hospital from January 2010 through July 2014 were included. Patients aged ? 18 or ? 90 years, with concurrent arteriovenous malformation, treated with both clipping and coiling, or not receiving definitive treatment were excluded. Both clinical and radiological variables were analyzed by univariate and multivariate logistic model to identify factors independently associated with outcome of SDH following aSAH.

RESULTS: Overall, 33 patients (36.2%) developed SDH following aSAH after definitive treatment. Univariate analysis revealed age, emergency department (ED) white blood cell (WBC) count, hypernatremia, Hunt & Hess Grade, modified Fisher"s Grade, presentation of acute hydrocephalus, initial placement of external ventriculostomy, and post-operative central nervous system infection were clinically significant factors. Multivariate logistic regression showed ED WBC count >14,500/?L (OR 5.096, 95% CI 1.332 to 19.499, p=0.017), poor Hunt&Hess Grade (III, IV & V) (OR 3.562, 95% CI 1.081 to 11.737, p=0.037), and initial placement of external ventriculostomy (OR 4.294, 95% CI 1.125 to 16.393, p=0.033) were independent factors.CONCLUSION: Three early independent predictors of SDH were identified including poor Hunt&Hess Grade, initial placement of external ventriculostomy and ED leukocytosis. Early placement of a ventricular-peritoneal shunt after aSAH may shorten length of stay in hospital and in intensive care unit. Keywords : Aneurysmal subarachnoid hemorrhage, Shunt-dependent hydrocephalus, Clinical predictor, Outcome

Corresponding author : David Hung-Tsang YEN, hjyen@vghtpe.gov.tw