Role of EVD Placement in Patients with Hydrocephalus Secondary to Subarachnoid Hemorrhage and Need for Permanent Ventriculoperitoneal Shunt Placement
DOI:
https://doi.org/10.61919/jhrr.v3i2.243Keywords:
EVD, Hydrocephalus, SAH, Ventriculoperitoneal Shunt, Wean TrialsAbstract
Background: Subarachnoid hemorrhage (SAH), often caused by aneurysm rupture, is a critical neurosurgical condition frequently leading to hydrocephalus. Management typically involves the use of an external ventricular drain (EVD) to reduce intracranial pressure and drain cerebrospinal fluid (CSF). The transition from EVD to permanent ventriculoperitoneal shunt (VPS) placement is a pivotal decision in patient management, influenced by various factors.
Objective: This study aims to analyze the role of EVD placement in patients with hydrocephalus secondary to spontaneous SAH and the subsequent need for permanent VPS placement.
Methods: Conducted at Jinnah Postgraduate Medical Center, Karachi, over six months, this retrospective study included 30 patients. After securing hospital ethical committee approval, several parameters were recorded: age, gender, Glasgow Coma Scale (GCS) score, aneurysm details (size and location), vasospasm occurrence, EVD placement in ICU, duration of EVD placement, CSF output, clamp trials, and wean failures.
Results: Out of 30 patients, 8 (26.66%) required VPS placement. No significant difference was found in VPS placement regarding age, gender, GCS score, aneurysm treatment and location, vasospasm, and EVD placement in ICU. However, patients requiring VPS had statistically longer EVD duration (p=0.0001), larger aneurysm size, more wean trials, clamp trials, and instances of wean failure (p=0.0001).
Conclusion: The study highlights the complexities in managing hydrocephalus post-SAH, particularly the significant association between the need for VPS installation and factors like EVD duration, aneurysm size, and wean trial outcomes. It underscores the need for future prospective studies with larger sample sizes to better identify patients who would benefit from shunt insertion post-SAH.
Keywords: EVD, Hydrocephalus, SAH, Ventriculoperitoneal Shunt, Wean Trials.
Downloads
References
Lewis A, Kimberly WT. Prediction of ventriculoperitoneal shunt placement based on type of failure during external ventricular drain wean. Clin Neurol Neurosurg. 2014;125(1):109-113.
Wang Y-M, Lin Y-J, Chuang M-J, Lee T-H, Tsai N-W, Cheng B-C, et al. Predictors and outcomes of shunt-dependent hydrocephalus in patients with aneurysmal sub-arachnoid hemorrhage. BMC Surg. 2012;12(1):1-8.
Kang D-H, Park J, Park S-H, Kim Y-S, Hwang S-K, Hamm I-S. Early ventriculoperitoneal shunt placement after severe aneurysmal subarachnoid hemorrhage: role of intraventricular hemorrhage and shunt function. Neurosurgery. 2010;66(5):904-909.
Orrego-González E, Enriquez-Marulanda A, Ascanio LC, Jordan N, Hanafy KA, Moore JM, et al. A cohort comparison analysis of fixed pressure ventriculoperitoneal shunt valves with programmable valves for hydrocephalus following nontraumatic subarachnoid hemorrhage. Operative Neurosurgery. 2020;18(4):374-383.
Chan M, Alaraj A, Calderon M, Herrera SR, Gao W, Ruland S, et al. Prediction of ventriculoperitoneal shunt dependency in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg. 2009;110(1):44-49.
Esposito DP, Goldenberg FD, Frank JI, Ardelt AA, Roitberg BZ. Permanent cerebrospinal fluid diversion in subarachnoid hemorrhage: influence of physician practice style. Surg Neurol Int. 2011;2.
Brandner S, Xu Y, Schmidt C, Emtmann I, Buchfelder M, Kleindienst A. Shunt-dependent hydrocephalus following subarachnoid hemorrhage correlates with increased S100B levels in cerebrospinal fluid and serum. In: Intracranial Pressure and Brain Monitoring XIV. Springer; 2012. p. 217-220.
Yamada S, Nakase H, Park Y-S, Nishimura F, Nakagawa I. Discriminant analysis prediction of the need for ventriculoperitoneal shunt after subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2012;21(6):493-497.
Hoh BL, Kleinhenz DT, Chi Y-Y, Mocco J, Barker II FG. Incidence of ventricular shunt placement for hydrocephalus with clipping versus coiling for ruptured and unruptured cerebral aneurysms in the Nationwide Inpatient Sample database: 2002 to 2007. World Neurosurg. 2011;76(6):548-554.
Gallina P, Lastrucci G, Caini S, Di Lorenzo N, Porfirio B, Scollato A. Accuracy and safety of 1-day external lumbar drainage of CSF for shunt selection in patients with idiopathic normal pressure hydrocephalus. J Neurosurg. 2018;131(4):1011-1017.
Nielsen N, Breedt A. Hydrocephalus. In: Nursing care of the pediatric neurosurgery patient. Springer; 2017. p. 39-89.
Lillemoe K, Lord A, Torres J, Ishida K, Czeisler B, Lewis A. Factors associated with code status in acute neurologic illness (P4. 337). AAN Enterprises; 2018.
Chen Z, Chen G, Song W, Liu L, Yang Y, Ling F. Rehabilitation combined with ventriculoperitoneal shunt for patients with chronic normal pressure hydrocephalus due to aneurysm subarachnoid haemorrhage: a preliminary study. J Rehabil Med. 2009;41(13):1096-1099.
O'Kelly CJ, Kulkarni AV, Austin PC, Urbach D, Wallace MC. Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage: incidence, predictors, and revision rates. J Neurosurg. 2009;111(5):1029-1035.
Nam K-H, Hamm I-S, Kang D-H, Park J, Kim Y-S. Risk of shunt dependent hydrocephalus after treatment of ruptured intracranial aneurysms: surgical clipping versus endovascular coiling according to Fisher grading system. J Korean Neurosurg Soc. 2010;48(4):313.
Guzman R. Abstracts of the 2021 Annual Virtual Meeting of the Swiss Society of Neurosurgery, September 16–17, 2021. Clin Transl Neurosci. 2021;5(2):19.
Perry A, Graffeo C, Kleinstern G, Carlstrom L, Link M, Rabinstein A. Quantitative modeling of external ventricular drain output to predict shunt dependency in aneurysmal subarachnoid hemorrhage: cohort study. Neurocrit Care. 2020;33(1):218-229.
Wang YC, Wang XQ, Tan CW, Wang CS, Tang Z, Zhang ZP, Xiao GL. Hydrocephalus after aneurysmal subarachnoid hemorrhage: Epidemiology, Pathogenesis, Diagnosis, and Management. Signa Vitae. 2021;17(4).
Konovalov A, Shekhtman O, Pilipenko Y, Okishev D, Ershova O, Oshorov A, Eliava S. External Ventricular Drainage in Patients With Acute Aneurysmal Subarachnoid Hemorrhage After Microsurgical Clipping: Our 2006-2018 Experience and a Literature Review. Cureus. 2021;13(1).
Ascanio LC, Gupta R, Adeeb N, Moore JM, Griessenauer CJ, Mayeku J, Thomas AJ. Relationship between external ventricular drain clamp trials and ventriculoperitoneal shunt insertion following nontraumatic subarachnoid hemorrhage: a single-center study. J Neurosurg. 2018;130(3):956-962.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Amjad Ali Shah, Iram Bokhari, Rabail Akbar, Tanweer Ahmed, Faizyab Ahmed, Muhammad Daniyal Mumtaz

This work is licensed under a Creative Commons Attribution 4.0 International License.
Public Licensing Terms
This work is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). Under this license:
- You are free to share (copy and redistribute the material in any medium or format) and adapt (remix, transform, and build upon the material) for any purpose, including commercial use.
- Attribution must be given to the original author(s) and source in a manner that is reasonable and does not imply endorsement.
- No additional restrictions may be applied that conflict with the terms of this license.
For more details, visit: https://creativecommons.org/licenses/by/4.0/.