Permanent ventricular shunt and risk of meningitis: Challenges in weaning from external ventricular drain

Aneurysmal subarachnoid hemorrhage (SAH) is a severe condition associated with high mortality and morbidity. Acute hydrocephalus is a common complication that often necessitates external ventricular drainage (EVD) and, in some cases, permanent shunt placement. Determining the optimal timing for EVD weaning remains challenging, as it requires balancing the need for permanent shunting against the risk of meningitis.

This retrospective cohort study analysed aneurysmal SAH patients requiring EVD at Rouen University Hospital between January 2020 and December 2022. Predictive factors for successful weaning, the risk of meningitis, and the impact of weaning attempt timing on outcomes were assessed.

A total of 63 patients were included. Successful weaning was achieved in 37 cases (58.7%), while 26 patients (41.3%) required a ventriculoperitoneal shunt (VPS). Younger age, minimal comorbidities, higher Glasgow Coma Scale (GCS) scores (≥10), and limited intraventricular haemorrhage were significantly associated with weaning success. Meningitis cases exhibited a bimodal distribution, with an early peak related to procedural factors, and a second peak which coincided with EVD failure attempt. Most weaning attempts performed within the first 14 days post-SAH resulted in false failure attempts, and repeated attempts were sometimes successful.

These findings underscore that EVD weaning remains a complex clinical challenge, characterized by multifaceted risks requiring careful management and highlighting the need for refined weaning strategies.