Journal of Korean Society of Geriatric Neurosurgery 2019;15(1):1-7.
Published online June 30, 2019.
Predictors of Shunt-dependent Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage in Elderly Patients: Duration of Cerebrospinal Fluid Drainage
Donghyun Won1, Ja Myoung Lee1, Dong Hyun Chun1, Young Seok Lee1, Kwangho Lee1, Hyun Park2, Dong Ho Kang1, Chul Hee Lee1, Soo Hyun Hwang2, Jin Myung Jung1, Jongwoo Han1, In Sung Park1,3
1Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
2Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
3Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
The incidence of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage(aSAH) ranges from 2% to 48%. Hydrocephalus is likely to cause neurological deficits, which may lead to poor prognosis. This study aimed to identify predictors of shunt-dependent hydrocephalus and effect of cerebrospinal fluid(CSF) drainage. Methods: We retrospectively reviewed the medical records of 82 patients(≥65 years) who were treated with surgery for aSAH between January 2012 and February 2017. The patients were divided into two groups: shunted and non-shunted. The patients who had CSF drainage were divided into two groups: long-term and short-term. We investigated the incidence of shunt-dependent hydrocephalus and risk factor according to age, sex, aneurysmal site, Hunt & Hess grade, Fisher grade, World Federation of Neurosurgical Societies grade, treatment of aSAH, Glasgow outcome scale, medical problems, vasospasm, CSF drainage, hydrocephalus on admission, intraventricular hemorrhage and hypertension. Results: The incidence of hydrocephalus following aSAH was 68.2%, and shunt-dependent hydrocephalus was 26.7% in 82 patients. Significant predictors of shunt dependency were poor Hunt and Hess grade at admission(p-value=0.013), presence of ventriculomegaly(p-value 0.019), lower Glasgow outcome scale(p-value=0.04), and CSF drainage(p-value =0.049). Also, shunt-dependent hydrocephalus was associated with long duration of CSF drainage(p-value=0.036). Conclusion: The presence of CSF drainage seems to be predictive of shunt insertion after aSAH. Also, long duration of CSF drainage may be associated with the shunt-dependent hydrocephalus. These findings may help identify patients at greatest risk of shunt insertion and inform treatment decisions.
Key Words: Hydrocephalus, Subarachnoid hemorrhage, Cerebrospinal fluid, Cerebrospinal fluid shunts

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