Turkish Neurosurgery
Unlocking the Battle: Clipping vs. Endovascular Therapy for Shunt-Dependent Hydrocephalus After Aneurysm Rupture – An In-Depth Institutional Analysis
Vikas chandra Jha1, Rahul Jain2, Vivek Saran Sinha3, Nitish Kumar4
1All India Institute of medical sciences patna, Neurosurgery, Patna,
2All India Institute of medical sciences, Patna., Neurosurgery, Patna,
3All India Institute of medical sciences, Patna., Neurosurgery, Patna,
4All India Institute of medical sciences, Patna., Neurosurgery, Patna,
DOI: 10.5137/1019-5149.JTN.45739-23.1

Aim:Subarachnoid haemorrhage (SAH) often leads to shunt-dependent hydrocephalus (SDH). This study compares microsurgical clipping and endovascular therapy (EVT) for managing SDH in SAH patients with hydrocephalus.Material and Methods:A retrospective study conducted from July 2018 to December 2022 included 67 SAH patients with acute hydrocephalus. Data on demographic, clinical, and radiological parameters, such as age, gender, GCS scores, Hunt and Hess grade, Fischer score, EVD duration, complications, Omaya reservoir placement, CSF drainage, and outcomes, were collected. Statistical analyses, including univariate analysis and stepwise logistic regression, identified significant risk factors for shunt dependence.Results:Among the 67 patients, 33 underwent microsurgical clipping, and 34 received EVT. Spasmolysis reduced shunt dependency, while early EVD placement correlated with reduced shunt dependence (p = 0.002). The Omaya reservoir helped manage meningitis but was associated with shunt dependency (p = 0.04). Perioperative infarct was a significant risk factor for shunt dependence on multiple logistic regression analysis (p = 0.05). No significant difference was observed in patient outcomes between the two treatment groups. However, EVT patients had shorter ICU and hospital stays.Conclusion:This study underscores that clinical vasospasm management through spasmolysis may reduce shunt dependency. Overall, both microsurgical clipping and EVT offer similar long-term outcomes and efficacy to prevent shunt dependence, but EVT has the advantage of shorter hospital stays. These findings provide crucial insights for clinical decision-making and patient care in SDH following SAH.

Corresponding author : Vikas chandra Jha