Unlocking the Battle-Clipping vs. Endovascular Therapy for Shunt-Dependent Hydrocephalus After Aneurysm Rupture: An...

Area of Science:

• Neurosurgery
• Interventional Neurology
• Critical Care Medicine

Background:

• Subarachnoid hemorrhage (SAH) frequently leads to hydrocephalus, necessitating interventions like shunt placement.
• Shunt-dependent hydrocephalus (SDH) presents a significant management challenge post-SAH.
• Comparing treatment modalities for SDH is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare microsurgical clipping and endovascular therapy (EVT) for managing SDH in SAH patients.
• To identify risk factors associated with shunt dependence after SAH.
• To evaluate the efficacy and outcomes of different hydrocephalus management strategies.

Main Methods:

• Retrospective study of 67 patients with SAH and acute hydrocephalus (July 2018-December 2022).
• Data collected included demographics, clinical scores, EVD duration, complications, and outcomes.
• Statistical analyses involved univariate and stepwise logistic regression to determine risk factors for shunt dependence.

Main Results:

• 33 patients underwent microsurgical clipping, and 34 received EVT.
• Early external ventricular drain (EVD) placement and spasmolysis correlated with reduced shunt dependence.
• Perioperative infarct was a significant risk factor for shunt dependence; EVT resulted in shorter ICU and hospital stays.

Conclusions:

• Both microsurgical clipping and EVT demonstrate comparable long-term efficacy for preventing shunt dependence in SAH.
• Managing vasospasm with spasmolysis may decrease the likelihood of shunt dependency.
• Endovascular therapy (EVT) offers the advantage of a shorter hospital stay compared to microsurgical clipping.