The Risk Factors Analysis And Prediction For The Shunt-dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage

OBJECTIVEThis study was designed to identify the predictors and independent predictors of shunt-dependent hydrocephalus in the patients with aneurysmal subarachnoid hemorrhage.A prediction model was made according to the independent predictors to identify the high-risk population for requiring permanent cerebrospinal fluid diversion among the patients with ruptured intracranial aneurysm.METHODS1031 patients with intracranial aneurysm were studied respectively from 1st January to 31 st December of 2014.After the preliminary screening,the statistical analysis was made among the 420 patients which met the enrollment condition.Chi-square test,Fisher exact test and Student t-test were performed to identify the predictor of the need for a permanent shunt.Binary logistic regression was conducted to determine the independent predictors.Finally,based on all the statistical analyses above,a prediction model for shunt-dependent hydrocephalus was developed.RESULTSOverall,57 of the 420 patients(57/420;13.6%)needed a permanent shunt.Univariate analysis showed that the following predictors are highly associated with the development of permanent shunt: 1.age(no more than 60 versus older than 60);2.Hunt-Hess grade;3.Modified Fisher grade;4.IVH;5.acute stage hydrocephalus;6.size of aneurysms;7.location of aneurysms(anterior circulation versus posterior circulation);8.rebleeding;9.diabetes;10.smoking;11.surgical clipping or endovascular coiling(Hunt-Hess grade from ?-?);12.decompressive craniectomy;13.lumbar cistern drainage;14.hypertension(moderate group versus and severe group);15.CSF replacement.The binary logistic regression indicated that Modified Fisher grade,acute stage hydrocephalus,decompressive craniectomy,CSF replacement,rebleeding are independent predictors for the shunt-dependent hydrocephalus.CONCLUSIONAge,Hunt-Hess grade,Modified Fisher grade,IVH,acute stage hydrocephalus,size of aneurysms,rebleeding,diabetes,smoking,treatment methods,decompressive craniectomy,lumbar cistern drainage,hypertension and CSF replacement are considered predictors and Modified Fisher grade,acute stage hydrocephalus,decompressive craniectomy,CSF replacement,rebleeding are independent predictors for the shunt-dependent hydrocephalus.Patients with Hunt-Hess grade from ? to ? are advised to choose endovascular coiling and routine using of CSF replacement if the condition permits.The prediction model proposed in this study may help the clinical doctors to identify the high-risk patients of developing shunt-dependent hydrocephalus and perform necessary early stage preventions.