Document Detail


Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage: incidence, predictors, and revision rates. Clinical article.
MedLine Citation:
PMID:  19361256     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: Chronic shunt-dependent hydrocephalus is a recognized complication of aneurysmal subarachnoid hemorrhage. While its incidence and risk factors have been well described, the long-term performance of shunts in this setting has not been not widely reported. METHODS: Using administrative databases, the authors derived a retrospective cohort of patients undergoing treatment of a ruptured aneurysm in Ontario, Canada, between 1995 and 2005. The authors determined the incidence of shunt-dependent hydrocephalus and analyzed putative risk factors. Mortality rates and indicators of morbidity were recorded. Patients were followed up for the occurrence of shunt failure over time. RESULTS: Of 3120 patients in the cohort, 585 (18.75%) developed shunt-dependent hydrocephalus. On multivariate analysis, age, acute hydrocephalus, ventilation on admission, aneurysms in the posterior circulation and giant aneurysms were all significant predictors of shunt-dependent hydrocephalus. The mortality rate was not increased in patients with chronic hydrocephalus (hazard ratio 1.04, p = 0.63); however, indicators of morbidity were increased in these patients. Of the 585 patients with shunt-dependent hydrocephalus, only 173 (29.6%) underwent a subsequent revision procedure. Ninety-eight percent of these revisions were completed within 6 months. Subsequent revisions occurred more frequently. On multivariate analysis, significant predictors of shunt revision included aneurysm location in the posterior circulation and endovascular treatment of the initial ruptured aneurysm. CONCLUSIONS: Shunt-dependent hydrocephalus affects a significant proportion of subarachnoid hemorrhage survivors, contributing to additional morbidity among these patients. Shunt failures occur less frequently in patients who underwent treatment for a ruptured aneurysm than with other forms of hydrocephalus. Most failures occur within 6 months, suggesting that shunt dependency may be transient in the majority of patients.
Authors:
Cian J O'Kelly; Abhaya V Kulkarni; Peter C Austin; David Urbach; M Christopher Wallace
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  111     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-02     Completed Date:  2009-11-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1029-35     Citation Subset:  AIM; IM    
Affiliation:
Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada. cianokelly@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Chronic Disease
Female
Humans
Hydrocephalus / etiology*
Kaplan-Meiers Estimate
Male
Middle Aged
Neurosurgical Procedures
Ontario / epidemiology
Predictive Value of Tests
Reoperation
Retrospective Studies
Risk Factors
Subarachnoid Hemorrhage / complications*,  epidemiology,  surgery
Ventriculoperitoneal Shunt*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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