Related Experiment Video
Updated: May 7, 2026
09:00
The Rabbit Blood-shunt Model for the Study of Acute and Late Sequelae of Subarachnoid Hemorrhage: Technical Aspects
Published on: October 2, 2014
13.7K
Risk factors for shunt-dependent hydrocephalus after spontaneous subarachnoid hemorrhage
Loreto Esteban Estallo1, Juan Casado Pellejero1, Silvia Vázquez Sufuentes1
1Hospital Universitario Miguel Servet, Zaragoza, Spain.
Neurocirugia (English Edition)
|March 7, 2024
Summary
High Fisher grade and external ventricular drain (EVD) use predict shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH). Shunt infections are the primary cause of reoperation, suggesting early shunt placement may reduce complications.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Subarachnoid hemorrhage (SAH) is a critical neurosurgical emergency, often caused by ruptured intracranial aneurysms.
- Hydrocephalus is a frequent complication of aneurysmal SAH, leading to significant morbidity.
- Ventriculoperitoneal shunts are commonly used to manage hydrocephalus but carry their own risks.
Purpose of the Study:
- To identify predictors of shunt-dependent hydrocephalus following aneurysmal SAH.
- To quantify the complications associated with ventriculoperitoneal shunts in this patient population.
Main Methods:
- Retrospective analysis of spontaneous SAH patients admitted between 2017-2022.
- Data collection included clinical, radiological, and treatment characteristics.
- Statistical analysis identified risk factors for hydrocephalus requiring shunting.
Main Results:
- 11.7% of aneurysmal SAH patients developed shunt-dependent hydrocephalus.
- High modified Fisher scale grade and external ventricular drain (EVD) placement were significant predictors.
- Shunt reoperation rate was 17.7%, primarily due to infection.
Conclusions:
- High Fisher grade and prior EVD are key risk factors for shunt-dependent hydrocephalus post-aneurysmal SAH.
- Shunt infection remains the leading cause for reoperation.
- Consideration of early shunt placement in select patients may mitigate infectious complications.
Keywords:
Aneurisma intracranealDerivación ventrículoperitonealHemorragia subaracnoideaHidrocefaliaHydrocephalusIntracranial aneurysmSubarachnoid haemorrhageVentriculoperitoneal shuntMore Related Videos
Related Concept Videos
01:17Hemorrhagic Stroke l: Introduction
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
01:29Hemorrhagic Stroke ll: Pathophysiology
A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
01:26Bacterial Meningitis II: Pathophysiology
Bacterial meningitis typically begins when pathogens such as Neisseria meningitidis and Streptococcus pneumoniae colonize the nasopharynx and invade the bloodstream. This process is facilitated by bacterial virulence factors, such as polysaccharide capsules, which resist phagocytosis and complement-mediated killing. Less commonly, bacteria reach the central nervous system via contiguous spread from infections like otitis media or sinusitis, through congenital or acquired dural defects, or...
01:14Increased Intracranial Pressure l: Introduction
Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
01:29Increased Intracranial Pressure ll: Pathophysiology
Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
01:22Cerebral Edema ll: Pathophysiology
Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...