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Predicting the need for cerebrospinal fluid shunt implantation after spontaneous intracerebral hemorrhage: a
Farjad Khalaveh1, Vitalij Zeiser1, Anna Cho1
1Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
Insights
Predicting cerebrospinal fluid (CSF) shunt dependency after intracerebral hemorrhage (ICH) is crucial. Volumetric analysis of hemorrhage and CSF, along with acute hydrocephalus, can help identify patients needing a shunt.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Persistent hydrocephalus requiring cerebrospinal fluid (CSF) shunt is a complication of spontaneous intracerebral hemorrhage (ICH).
- Predictive factors for shunt dependency after ICH are not well-established, leading to variable clinical outcomes.
Purpose of the Study:
- To identify predictive factors for cerebrospinal fluid (CSF) shunt dependency in patients following spontaneous intracerebral hemorrhage (ICH).
Main Methods:
- Retrospective analysis of 99 neurosurgically treated patients with spontaneous ICH.
- Comparison of variables including hemorrhage location, acute hydrocephalus, and volumetric analysis of ICH, intraventricular hemorrhage (IVH), and intraventricular CSF between shunted and non-shunted patients.
- Receiver operating characteristic (ROC) analysis for volumetric parameters.
Main Results:
- Thalamic and cerebellar ICH locations were associated with higher rates of CSF-shunt implantation.
- A lower hemorrhage to intraventricular CSF volume ratio, greater IVH in the third ventricle, acute hydrocephalus, and increased intraventricular CSF volume predicted shunt dependency.
- ROC analysis yielded an AUC of 0.835 for predicting shunt necessity.
Conclusions:
- Volumetric analysis of intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH), and intraventricular CSF can enhance prediction of CSF shunt implantation after spontaneous ICH.
- Identifying these factors may aid in clinical decision-making for shunt placement.
Objectives:
The development of persistent hydrocephalus in patients after spontaneous intracerebral hemorrhage (ICH) is still poorly understood, and many variables predicting the need for a cerebrospinal fluid (CSF)-shunt have been described in the literature with varying results. The aim of this study is to find predictive factors for shunt dependency.
Methods:
We performed a retrospective, single-center study of 99 neurosurgically treated patients with spontaneous ICH. Variables, including age, Glasgow Coma Scale (GCS), intraventricular hemorrhage (IVH), location of hemorrhage, acute hydrocephalus, and volumetric analysis of IVH, ICH, and intraventricular CSF were compared between patients with and without CSF-shunt implantation. Furthermore, receiver operating characteristics (ROC) for ICH, IVH, and intraventricular CSF volume parameters were calculated.
Results:
CSF-shunt implantation was performed significantly more often in patients after thalamic (p = 0.03) and cerebellar ICH (p = 0.04). Moreover, a lower ratio between the total hemorrhage volume and intraventricular CSF volume (p = 0.007), a higher IVH distribution in the third ventricle, and an acute hydrocephalus (p < 0.001) with an increased intraventricular CSF volume (p < 0.001) were associated with shunt dependency. Our ROC model demonstrated a sensitivity of 82% and a specificity of 65% to predict the necessity for a shunt at a cutoff value of 1.9 with an AUC of 0.835.
Conclusion:
Volumetric analysis of ICH, IVH, and intraventricular CSF may improve the prediction of CSF shunt implantation in patients with spontaneous ICH.
