Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0040-1710149
Factors Associated with the Need for Ventriculoperitoneal Shunting in Patients with Spontaneous Intracerebral Hemorrhage Requiring Emergency Cerebrospinal Fluid Diversion
FundingNone.![](https://www.thieme-connect.de/media/10.1055-s-00028728/202002/lookinside/thumbnails/10-1055-s-0040-1710149_00006-1.jpg)
Abstract
Introduction Intracerebral hemorrhage (ICH) is a serious medical condition that is frequently complicated by acute hydrocephalus, necessitating emergency cerebrospinal fluid (CSF) diversion in a subset of patients, ultimately requiring long-term treatment via placement of permanent ventricular shunts. The present study aimed to determine factors associated with the need for permanent ventricular shunt placement in these patients.
Methods A total of 309 consecutive patients who underwent emergent CSF diversion with external ventricular drain (EVD) as a treatment for ICH between July 2009 and July 2018 were studied retrospectively to assess the factors that might be correlated with shunt-dependent chronic hydrocephalus. A binary logistic regression model was designed to identify independent related factors of shunt-dependent hydrocephalus after ICH.
Results Of 309 patients included in this study, 102 (33.00%) required permanent ventricular CSF shunting before discharge. In univariate analysis, age,ventriculitis, ICP elevation >30 mm Hg, ICH evacuation, the Graeb score, days of EVD in place, and CSF protein levels were significantly associated with the requirement for permanent CSF diversion (p < 0.05). The age and ICH evacuation were protective variables and the ventriculoperitoneal (VP) shunt possibility was reduced by 22.6 and 63.5%, respectively.
Conclusion Our results showed that higher Graeb score, ICP elevation >30 mm Hg, more days of EVD in place, and higher CSF protein levels were associated with permanent CSF diversion in these patients. Advanced age and ICH evacuation decreased the possibility of VP shunting in our study.These factors may help in predicting which patients will need permanent CSF diversion and could ultimately lead to improvements in the management of these patients.
Keywords
intracerebral hemorrhage - hydrocephalus - cerebrospinal fluid diversion - external ventricular drain - ventriculoperitoneal shuntPublication History
Article published online:
10 June 2020
© .
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
-
References
- 1 Gaberel T, Magheru C, Parienti JJ, Huttner HB, Vivien D, Emery E. Intraventricular fibrinolysis versus external ventricular drainage alone in intraventricular hemorrhage: a meta-analysis. Stroke 2011; 42 (10) 2776-2781
- 2 O’Kelly CJ, Kulkarni AV, Austin PC, Urbach D, Wallace MC. Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage: incidence, predictors, and revision rates. Clinical article. J Neurosurg 2009; 111 (05) 1029-1035
- 3 Rincon F, Gordon E, Starke RM. et al. Predictors of long-term shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. Clinical article. J Neurosurg 2010; 113 (04) 774-780
- 4 Trifan G, Arshi B, Testai FD. Intraventricular hemorrhage severity as a predictor of outcome in intracerebral hemorrhage. Front Neurol 2019; 10: 217
- 5 Yang TC, Chang CH, Liu YT, Chen YL, Tu PH, Chen HC. Predictors of shunt-dependent chronic hydrocephalus after aneurysmal subarachnoid haemorrhage. Eur Neurol 2013; 69 (05) 296-303
- 6 Zaidi HA, Montoure A, Elhadi A. et al. Long-term functional outcomes and predictors of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms in the BRAT trial: revisiting the clip vs coil debate. Neurosurgery 2015; 76 (05) 608-613, discussion 613–614, quiz 614
- 7 Li Q, Huang YJ, Zhang G. et al. Intraventricular Hemorrhage and Early Hematoma Expansion in Patients with Intracerebral Hemorrhage. Sci Rep 2015; 5: 11357
- 8 Lenski M, Biczok A, Huge V. et al. Role of cerebrospinal fluid markers for predicting shunt-dependent hydrocephalus in patients with subarachnoid hemorrhage and external ventricular drain placement. World Neurosurg 2019; 121: e535-e542
- 9 Klahr AC, Kate M, Kosior J. et al. Early hematoma retraction in intracerebral hemorrhage is uncommon and does not predict outcome. PLoS One 2018; 13 (10) e0205436
- 10 Ironside N, Chen CJ, Dreyer V, Christophe B, Buell TJ, Connolly ES. Location-specific differences in hematoma volume predict outcomes in patients with spontaneous intracerebral hemorrhage. Int J Stroke 2020; 15 (01) 90-102
- 11 Huang YW, Yang MF. Combining investigation of imaging markers (island sign and blend sign) and clinical factors in predicting hematoma expansion of intracerebral hemorrhage in the Basal Ganglia. World Neurosurg 2018; 120: e1000-e1010
- 12 LeRoux PD, Haglund MM, Newell DW, Grady MS, Winn HR. Intraventricular hemorrhage in blunt head trauma: an analysis of 43 cases. Neurosurgery 1992; 31 (04) 678-684, discussion 684–685
- 13 Zacharia BE, Vaughan KA, Hickman ZL. et al. Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion. Neurosurg Focus 2012; 32 (04) E5
- 14 Miller C, Tsivgoulis G, Nakaji P. Predictors of ventriculoperitoneal shunting after spontaneous intraparenchymal hemorrhage. Neurocrit Care 2008; 8 (02) 235-240
- 15 Garg R, Biller J. Recent advances in spontaneous intracerebral hemorrhage. F1000 Res 2019; 8: 8
- 16 Ziai WC, Torbey MT, Naff NJ. et al. Frequency of sustained intracranial pressure elevation during treatment of severe intraventricular hemorrhage. Cerebrovasc Dis 2009; 27 (04) 403-410
- 17 Wang YM, Lin YJ, Chuang MJ. et al. Predictors and outcomes of shunt-dependent hydrocephalus in patients with aneurysmal sub-arachnoid hemorrhage. BMC Surg 2012; 12: 12
- 18 Witsch J, Bruce E, Meyers E. et al. Intraventricular hemorrhage expansion in patients with spontaneous intracerebral hemorrhage. Neurology 2015; 84 (10) 989-994
- 19 Chen CJ, Ding D, Ironside N. et al. ERICH investigators. Predictors of surgical intervention in patients with spontaneous intracerebral hemorrhage. World Neurosurg 2019; 123: e700-e708
- 20 Paisan GM, Ding D, Starke RM, Crowley RW, Liu KC. Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage: predictors and long-term functional outcomes. Neurosurgery 2018; 83 (03) 393-402