Ventriculoperitoneal Shunting After Aneurysmal Subarachnoid Hemorrhage: Analysis of the Indications Complications and Outcome With a Focus on Patients With Borderline Ventriculomegaly
OBJECTIVE: The goals of this study were to investigate the risk factors, indications, complications, and outcome for patients with ventriculoperitoneal shunts (VPSs) after subarachnoid hemorrhage and to define a subgroup eligible for future prospective studies designed to clarify indications for placement of a VPS. METHODS: Clinical characteristics of 236 prospectively evaluated patients with subarachnoid hemorrhage and 6 months of follow-up were analyzed. Hydrocephalus was estimated by the relative bicaudate index (RBCI) measured on computed tomographic scans at the time of shunting. Patients were divided into three groups by ventricle size: Group 1 included 121 patients with small ventricles (RBCI <1.0), Group 2 included 88 patients with borderline ventricle size (RBCI 1.0-1.4), and Group 3 included 27 patients with markedly enlarged ventricles (RBCI >1.4). RESULTS: Initially, 86 patients (36%) underwent ventriculoperitoneal shunting: 19 in Group 1 (16%), 43 in Group 2 (49%), and 24 in Group 3 (90%). Indications for placement of a VPS, risk factors, and outcome differed markedly by group. Four patients (3% of those not initially shunted) developed delayed hydrocephalus requiring a VPS, including one in Group 2 (2%). The 6-month shunt complication rate was 13%. Evaluation of patients in Group 2 indicated that functional status was an important factor in selecting candidates for shunting, and that patients receiving shunts and shunt-free patients demonstrated improvement in functional status during follow-up. CONCLUSION: Although we currently use a proactive shunting paradigm for posthemorrhagic hydrocephalus, this report demonstrates that a conservative approach to patients with borderline ventricle size (i.e., RBCI of 1.0-1.4) and normal intracranial pressure should be evaluated in a prospective randomized trial. Copyright Â© by the Congress of Neurological Surgeons.
Digital Object Identifier (DOI)
Little, Andrew S.; Zabramski, Joseph M.; Peterson, Madelon; Goslar, Pamela W.; Wait, Scott D.; Albuquerque, Felipe C.; McDougall, Cameron G.; and Spetzler, Robert F., "Ventriculoperitoneal Shunting After Aneurysmal Subarachnoid Hemorrhage: Analysis of the Indications Complications and Outcome With a Focus on Patients With Borderline Ventriculomegaly" (2008). Neurosurgery. 507.