Shunt­dependent hydrocephalus after aneurysmal subarachnoid hemorrhage

J Neurosurg 111:1029–1035, 2009. DOI: 10.3171/2008.9.JNS08881

Chronic shunt­dependent hydrocephalus is a recognized complication of aneurysmal subarachnoid hem­ orrhage. While its incidence and risk factors have been well described, the long­term 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 treat­ ment of a ruptured aneurysm in Ontario, Canada, between 1995 and 2005. The authors determined the incidence of shunt­dependent 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 multivari­ ate 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 loca­ tion in the posterior circulation and endovascular treatment of the initial ruptured aneurysm.

Conclusions. Shunt-dependent hydrocephalus affects a significant proportion of subarachnoid hemorrhage sur­ vivors, 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.

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