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Updated: Jun 14, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Predictors of long-term shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. Clinical article
Fred Rincon1, Errol Gordon, Robert M Starke
1Department of Medicine, Division of Neurology, Critical Care, and Cardiovascular Medicine, Robert Wood Johnson Medical School, UMDNJ, Camden, New Jersey 08103, USA. Rincon-fred@cooperhealth.edu
Insights
Predictors of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH) include high admission glucose, specific CT scan findings like Fisher Grade 4, and nosocomial meningitis. These factors may help identify patients needing cerebrospinal fluid diversion.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Aneurysmal subarachnoid hemorrhage (SAH) can lead to hydrocephalus, often requiring cerebrospinal fluid (CSF) diversion.
- Identifying predictors of shunt dependency is crucial for patient management and resource allocation.
Purpose of the Study:
- To identify independent predictors of shunt-dependent hydrocephalus in patients following aneurysmal SAH.
- To inform clinical decision-making regarding the need for permanent CSF diversion.
Main Methods:
- Retrospective analysis of 580 consecutive aneurysmal SAH patients.
- Evaluation of demographics, admission variables, CT scan characteristics, and complications.
- Multivariate logistic regression to determine independent predictors of shunt dependency.
Main Results:
- Admission hyperglycemia (glucose ≥ 126 mg/dl) was associated with shunt dependency.
- Specific CT findings, including Fisher Grade 4, fourth ventricle hemorrhage, and bicaudate index ≥ 0.20, predicted shunt dependency.
- Development of nosocomial meningitis significantly increased the odds of requiring a shunt.
Conclusions:
- Hyperglycemia, specific CT findings (Fisher Grade 4, fourth ventricle hemorrhage, bicaudate index), and nosocomial meningitis are independent predictors of shunt dependency after aneurysmal SAH.
- Future research should explore interventions like glycemic control and meningitis prevention to reduce shunt requirement.
- These findings aid in predicting the need for permanent CSF diversion in SAH patients.
Object:
The purpose of this study was to identify predictors of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH).
Methods:
The authors evaluated the incidence of shunt-dependent hydrocephalus in a consecutive cohort of 580 patients with SAH who were admitted to the Neurological Intensive Care Unit of Columbia University Medical Center between July 1996 and September 2002. Patient demographics, 24-hour admission variables, initial CT scan characteristics, daily transcranial Doppler variables, and development of in-hospital complications were analyzed. Odds ratios and 95% CIs for candidate predictors were calculated using multivariate nominal logistic regression.
Results:
Admission glucose of at least 126 mg/dl (adjusted OR 1.6; 95% CI 1.0-2.6), admission brain CT scan with a bicaudate index of at least 0.20 (adjusted OR 1.43; 95% CI 1.0-2.0), Fisher Grade 4 (adjusted OR 2.71; 95% CI 1.2-5.7), fourth ventricle hemorrhage (adjusted OR 1.78; 95% CI 1.1-2.7), and development of nosocomial meningitis (adjusted OR 2.2; 95% CI 1.4-3.7) were independently associated with shunt dependency.
Conclusions:
These data suggest that permanent CSF diversion after aneurysmal SAH may be independently predicted by hyperglycemia at admission, findings on the admission CT scan (Fisher Grade 4, fourth ventricle intraventricular hemorrhage, and bicaudate index ≥ 0.20), and development of nosocomial meningitis. Future research is needed to assess if tight glycemic control, reduction of fourth ventricle clot burden, and prevention of nosocomial meningitis may reduce the need for permanent CSF diversion after aneurysmal SAH.
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