• World Neurosurg · Jan 2025

    Shunt-Dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage: Investigation of Prognostic Variables and Creation of a Stronger Predictive Model.

    • J Tanner McMahon, James G Malcolm, J Miller Douglas, Alex Greven, Ofer Sadan, Owen B Samuels, C Michael Cawley, Daniel L Barrow, Jonathan A Grossberg, and Brian M Howard.
    • Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA. Electronic address: jtmcmahon@bwh.harvard.edu.
    • World Neurosurg. 2025 Jan 24; 195: 123659123659.

    ObjectiveAneurysmal subarachnoid hemorrhage (SAH) is frequently complicated by permanent shunt-dependent hydrocephalus, but it is difficult to predict which patients are at highest risk. This study seeks to identify novel variables associated with shunt dependency after aneurysmal SAH and to create a predictive algorithm that improves upon existing models.MethodsRetrospective case-control design was used. Patients who presented with aneurysmal SAH and external ventricular drain (EVD) placement were included. Those who successfully weaned off their EVD were compared with those who required shunt placement. Demographic and treatment data were analyzed using univariate and multivariable logistic regression. Receiver operating characteristic was used to compare the proposed model's performance against existing ones (Barrow Neurological Institute, chronic hydrocephalus ensuing from SAH score, and shunt dependency in SAH scores).ResultsOne hundred patients were included: 50 no shunt and 50 shunt. Advanced age, elevated modified Graeb score, intraventricular hemorrhage, increased clot thickness, acute hydrocephalus, and cerebrospinal fluid protein >110 mg/dL prior to wean attempt were all found to be significantly associated with progression to shunt-dependency (P = 0.0351, 0.0022, 0.0407, 0.0274, 0.0014, and 0.0064, respectively). Multivariate regression demonstrated an area under the curve of 0.7852 (P < 0.0001), outperforming those of the other models.ConclusionsOur study suggests that elevated modified Graeb score on initial computed tomography and high cerebrospinal fluid protein levels prior to EVD wean are important prognostic indicators for the development of shunt dependency after aneurysmal SAH. Integrating these findings into clinical practice may aid in earlier and more targeted decision-making.Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…