Predictive factors for ventriculoperitoneal shunt placement in aneurysmatic subarachnoid hemorrhages

Aneurysmatic subarachnoid hemorrhages (aSAH) are life-threatening events with high mortality and morbidity. Hydrocephalus is a common complication, initially managed with an external ventricular drain (EVD). Persistent hydrocephalus often requires ventriculoperitoneal shunt (VPS) placement to relieve intracranial pressure and prevent further neurological damage.

What factors predict the need for VPS placement in patients with aSAH, and how does a new predictive model compare to the Mayo Age, Grades, EVD score (MAGE score)?

A retrospective study of 105 patients with aSAH treated with EVD between 2014 and 2023 was conducted. Patients were divided into two groups: those requiring VPS (n= 45) and those not requiring VPS (n= 60). Sociodemographic, clinical, and treatment variables were analysed, and a new predictive model (SAH-VP) was developed and compared to the MAGE score.

Patients who required VPS had higher WFNS scores on admission (p= 0.045), more infections requiring antibiotics (p= 0.002), more failed weaning attempts (p= 0.004), more failed closure attempts (p= 0.002), and longer EVD use (p< 0.01). The new SAH-VP model demonstrated an area under the curve (AUC) of 0.800.

There is no consensus on the factors predicting VPS need in SAH patients. This study identified key predictors and developed a new predictive model, SAH-VP, which could improve patient management by identifying those at higher risk of requiring VPS, offering an alternative to the existing MAGE score.