Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage

Zeena Dorai, Linda S. Hynan, Thomas A. Kopitnik, Duke Samson, Thomas H. Milhorat, Juha Hernesniemi, Marc P. Sindou

Research output: Contribution to journalArticle

180 Citations (Scopus)

Abstract

OBJECTIVE: The purpose of this study was to identify factors predictive of shunt-dependent hydrocephalus among patients with aneurysmal subarachnoid hemorrhage. The data can be used to predict which patients in this group have a high probability of requiring permanent cerebrospinal fluid diversion. METHODS: Seven hundred eighteen patients with aneurysmal subarachnoid hemorrhage who were treated between 1990 and 1999 were retrospectively studied, to identify factors contributing to shunt-dependent hydrocephalus. With these data, a stepwise logistic regression procedure was used to determine the effect of each variable on the development of hydrocephalus and to create a scoring system. RESULTS: Overall, 152 of the 718 patients (21.2%) underwent shunting procedures for treatment of hydrocephalus. Four hundred seventy-nine of the patients (66.7%) were female. Of the factors investigated, the following were associated with shunt-dependent hydrocephalus, as determined with a variety of statistical methods: 1) increasing age (P < 0.001), 2) female sex (P = 0.015), 3) poor admission Hunt and Hess grade (P < 0.001), 4) thick subarachnoid hemorrhage on admission computed tomographic scans (P < 0.001), 5) intraventricular hemorrhage (P < 0.001), 6) radiological hydrocephalus at the time of admission (P < 0.001), 7) distal posterior circulation location of the ruptured aneurysm (P = 0.046), 8) clinical vasospasm (P < 0.001), and 9) endovascular treatment (P = 0.013). The presence of intracerebral hematomas, giant aneurysms, or multiple aneurysms did not influence the development of shunt-dependent hydrocephalus. CONCLUSION: The results of this study can help identify patients with a high risk of developing shunt-dependent hydrocephalus. This may help neurosurgeons expedite treatment, may decrease the cost and length of hospital stays, and may result in improved outcomes.

Original languageEnglish (US)
Pages (from-to)763-771
Number of pages9
JournalNeurosurgery
Volume52
Issue number4
StatePublished - Apr 1 2003

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Subarachnoid Hemorrhage
Hydrocephalus
Aneurysm
Length of Stay
Ruptured Aneurysm
Hematoma
Cerebrospinal Fluid
Therapeutics
Logistic Models
Hemorrhage
Costs and Cost Analysis

Keywords

  • Aneurysm
  • Hydrocephalus
  • Subarachnoid hemorrhage
  • Ventriculoperitoneal shunt

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Dorai, Z., Hynan, L. S., Kopitnik, T. A., Samson, D., Milhorat, T. H., Hernesniemi, J., & Sindou, M. P. (2003). Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery, 52(4), 763-771.

Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. / Dorai, Zeena; Hynan, Linda S.; Kopitnik, Thomas A.; Samson, Duke; Milhorat, Thomas H.; Hernesniemi, Juha; Sindou, Marc P.

In: Neurosurgery, Vol. 52, No. 4, 01.04.2003, p. 763-771.

Research output: Contribution to journalArticle

Dorai, Z, Hynan, LS, Kopitnik, TA, Samson, D, Milhorat, TH, Hernesniemi, J & Sindou, MP 2003, 'Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage', Neurosurgery, vol. 52, no. 4, pp. 763-771.
Dorai Z, Hynan LS, Kopitnik TA, Samson D, Milhorat TH, Hernesniemi J et al. Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2003 Apr 1;52(4):763-771.
Dorai, Zeena ; Hynan, Linda S. ; Kopitnik, Thomas A. ; Samson, Duke ; Milhorat, Thomas H. ; Hernesniemi, Juha ; Sindou, Marc P. / Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. In: Neurosurgery. 2003 ; Vol. 52, No. 4. pp. 763-771.
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N2 - OBJECTIVE: The purpose of this study was to identify factors predictive of shunt-dependent hydrocephalus among patients with aneurysmal subarachnoid hemorrhage. The data can be used to predict which patients in this group have a high probability of requiring permanent cerebrospinal fluid diversion. METHODS: Seven hundred eighteen patients with aneurysmal subarachnoid hemorrhage who were treated between 1990 and 1999 were retrospectively studied, to identify factors contributing to shunt-dependent hydrocephalus. With these data, a stepwise logistic regression procedure was used to determine the effect of each variable on the development of hydrocephalus and to create a scoring system. RESULTS: Overall, 152 of the 718 patients (21.2%) underwent shunting procedures for treatment of hydrocephalus. Four hundred seventy-nine of the patients (66.7%) were female. Of the factors investigated, the following were associated with shunt-dependent hydrocephalus, as determined with a variety of statistical methods: 1) increasing age (P < 0.001), 2) female sex (P = 0.015), 3) poor admission Hunt and Hess grade (P < 0.001), 4) thick subarachnoid hemorrhage on admission computed tomographic scans (P < 0.001), 5) intraventricular hemorrhage (P < 0.001), 6) radiological hydrocephalus at the time of admission (P < 0.001), 7) distal posterior circulation location of the ruptured aneurysm (P = 0.046), 8) clinical vasospasm (P < 0.001), and 9) endovascular treatment (P = 0.013). The presence of intracerebral hematomas, giant aneurysms, or multiple aneurysms did not influence the development of shunt-dependent hydrocephalus. CONCLUSION: The results of this study can help identify patients with a high risk of developing shunt-dependent hydrocephalus. This may help neurosurgeons expedite treatment, may decrease the cost and length of hospital stays, and may result in improved outcomes.

AB - OBJECTIVE: The purpose of this study was to identify factors predictive of shunt-dependent hydrocephalus among patients with aneurysmal subarachnoid hemorrhage. The data can be used to predict which patients in this group have a high probability of requiring permanent cerebrospinal fluid diversion. METHODS: Seven hundred eighteen patients with aneurysmal subarachnoid hemorrhage who were treated between 1990 and 1999 were retrospectively studied, to identify factors contributing to shunt-dependent hydrocephalus. With these data, a stepwise logistic regression procedure was used to determine the effect of each variable on the development of hydrocephalus and to create a scoring system. RESULTS: Overall, 152 of the 718 patients (21.2%) underwent shunting procedures for treatment of hydrocephalus. Four hundred seventy-nine of the patients (66.7%) were female. Of the factors investigated, the following were associated with shunt-dependent hydrocephalus, as determined with a variety of statistical methods: 1) increasing age (P < 0.001), 2) female sex (P = 0.015), 3) poor admission Hunt and Hess grade (P < 0.001), 4) thick subarachnoid hemorrhage on admission computed tomographic scans (P < 0.001), 5) intraventricular hemorrhage (P < 0.001), 6) radiological hydrocephalus at the time of admission (P < 0.001), 7) distal posterior circulation location of the ruptured aneurysm (P = 0.046), 8) clinical vasospasm (P < 0.001), and 9) endovascular treatment (P = 0.013). The presence of intracerebral hematomas, giant aneurysms, or multiple aneurysms did not influence the development of shunt-dependent hydrocephalus. CONCLUSION: The results of this study can help identify patients with a high risk of developing shunt-dependent hydrocephalus. This may help neurosurgeons expedite treatment, may decrease the cost and length of hospital stays, and may result in improved outcomes.

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