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Updated: Jan 1, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
III. Ventricle diameter increase during ventricular drainage challenge - A predictor of shunt dependency after
Carolin Weigl1, Elisabeth Bruendl1, Petra Schoedel1
1Department of Neurosurgery, Regensburg University Medical Center , Regensburg, Germany.
Insights
The Failure Risk Index (FRI) formula for predicting shunt dependency after aneurysmal subarachnoid hemorrhage (aSAH) was not confirmed in this study. Increased third ventricle diameter may be a more reliable predictor for shunt dependency.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Hydrocephalus requiring shunt placement is a common complication following aneurysmal subarachnoid hemorrhage (aSAH).
- The Failure Risk Index (FRI) formula, developed by Chan et al. in 2009, aims to predict shunt dependency in subarachnoid hemorrhage (SAH) patients.
Purpose of the Study:
- To reevaluate the accuracy of the FRI formula in predicting shunt dependency in aSAH patients.
- To identify simpler and potentially more reliable predictors of shunt dependency after aSAH.
Main Methods:
- Retrospective analysis of 38 aSAH patients treated in a neuro-intensive care unit.
- Calculation of the FRI based on Chan et al.'s formula.
- Comparison of FRI predictions with actual shunt implantation outcomes and evaluation of third ventricle diameter changes.
Main Results:
- The FRI formula showed poor correlation with actual shunt dependency in 22% of patients requiring shunts and 33% of those not requiring shunts.
- An increase in the third ventricle diameter was predictive of failed EVD challenges in 67% of cases.
- A decrease in the third ventricle diameter was predictive of successful EVD challenges in 67% of cases.
Conclusions:
- The FRI formula's predictive accuracy for shunt dependency could not be confirmed in this aSAH patient cohort.
- The increase in third ventricle diameter appears to be a simpler and more reliable predictor of shunt dependency compared to the FRI.
Abstract:
Hydrocephalus with the need for shunt placement is a common sequela after aneurysmal subarachnoid hemorrhage (aSAH). In 2009 Chan et al. published a formula to predict shunt dependency in SAH patients, the failure risk index (FRI). We reevaluated the FRI within the aSAH population in our hospital and wanted to identify easier measurements forecast shunt dependency. We retrospectively analyzed data from patients with aSAH treated in our neuro-intensive care unit and calculated the FRI according to the paper by Chan et al. 2013 and data were compared to the results of Chan et al. 38 patients were included in this study, 24 female and 14 male. 38% suffered a SAH WFNS I, 19% WFNS II, 24% WFNS III, 5% WFNS IV and 14% WFNS V. 17 patients underwent a shunt implantation (group 1), 21 patients did not (group 2). The calculated FRI Index did not correlate with the expectancy of shunt implantation in 22% of the cases (group 1). In group 2 the FRI index and the prediction of shunt dependency did not match in 33% of the cases. Furthermore, we found the increase of the third ventricle diameter to be predictive in 67% for failed EVD challenge and the decrease of the third ventricle diameter predictive in 67% for successful EVD challenge. In this study, we were not able to confirm the results of the FRI designed by Chan et al within our patient population. Furthermore, we consider the increase of the third ventricle diameter to be a simpler and more reliable predictor of shunt dependency.
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