Shunt-dependent Hydrocephalus After Aneurysm Subarachnoid Hemorrhage: Predictors And Its Relationship With Lumbar Puncture

Objective:To identify predictors of shunt-dependent hydrocephalus(SDHC)after aneurysmal subarachnoid hemorrhage(aSAH)and determine the effect of postoperative lumbar puncture(LP)on the incidence of SDHC.Methods:We conducted a retrospective review of consecutive patients with aSAH who underwent open microsurgery in our hospital from January 2009 to May 2019.The inclusion criteria: 1.SAH from an aneurysm,confirmed by preoperative Computed tomography CT,CTA or DSA;2.history of repair by clipping the ruptured cerebral aneurysms within 72 hours;3.No hydrocephalus was found in the patient within 7days after surgery;4.No intracranial infection was found in the patients after surgery;5.Survival beyond the initial hospitalization.Univariate and multivariate analyses were performed to characterize risk factors for SDHC after aSAH.The incidence of SDHC in the LP and No LP groups were compared after propensity score matching analysis.Results:A total of 414 patients were enrolled in this study.SDHC developed in 50patients(12.0%).On multivariate analysis,age >55 years(P=0.004),angiographic vasospasm(P=0.014),intraventricular hemorrhage(IVH)(P=0.048),Glasgow Coma Scale(GCS)score ≤12 at presentation(P=0.046),and a history of postoperative LP(P<0.001)were independently associated with SDHC after aSAH.The cohort,matched with the propensity score,showed that the incidence of SDHC after LP was significantly higher than that without LP(19.0% vs 10.7%,P=0.009,OR 2.28,95%Cl 1.2–4.1).Conclusions:Those,including age >55 years,angiographic vasospasm,intraventricular hemorrhage,Glasgow Coma Scale score ≤12 at presentation,and Routine postoperative LP,may be related to the increased incidence of SDHC after aSAH;however,the relationship between CSF drainage volume and time and SDHC requires further study.Strategies for the treatment of ruptured aneurysms should be used to mitigate SDHC.Patients with SDHC risk factors require additional monitoring after surgery and short follow-up intervals may lead to the early detection of SDHC.