Original ArticlePredictors of Shunt-dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage? A Systematic Review and Meta-Analysis
Section snippets
Background
Aneurysmal subarachnoid hemorrhage (aSAH) is a common but devastating disease. It is associated with a high fatality rate that varies from 27%–44% in different regions, leaving 8%–20% patients with persistent dependence.1 Hydrocephalus is a well-known complication after aSAH that was first recognized by Bagley in 1928.2 As defined by Vale in 1997, hydrocephalus after aSAH can be divided into 3 stages (acute stage, 48–72 hours after SAH; subacute stage, 3–14 days; chronic stage: >14 days).3 The
Methods
The methodology of this study is in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (checklist provided in Supplementary material).
Study Selection
A total of 3647 publications were identified through our initial database search. After screening the titles, abstracts, and key words, 3620 duplicates or irrelevant articles were excluded according to our prescribed criteria. Twenty-five studies were included in a detailed assessment. The PRISMA flow diagram of the publication selection is presented in Figure 1.
Study Characteristics
Table 1 summarizes the main characteristics of the included studies. These studies were published between 1993 and 2016, with sample
Discussion
A meta-analysis published by Wilson et al.33 identified several risk factors of shunt dependency in patients with aSAH, including increased age, high Hunt-Hess Scale scores, high Fisher grades, acute hydrocephalus, presence of intraventricular blood, posterior circulation location of the aneurysm in-hospital complications, and rebleeding. With an update of the literature review and modified inclusion criteria, our study covered all the risk factors reported by Wilson et al.33 and analyzed every
Conclusions
In conclusion, this study indicated that increased age, female gender, high Hunt-Hess grades, low GCS scores (GCS score ≤8), high Fisher grades (Fisher grade ≥3), acute hydrocephalus, EVD insertion, IVH, postcirculation aneurysm, AcomA aneurysm, clinical vasospasm, meningitis, and rebleeding were predictors of SDHC after aSAH. Controversial evidence on coiling as a potential risk factor has been reported among studies with different designs. Current published data were insufficient to support
Acknowledgments
We would like to thank Dr. Lu Ma, associate professor at the Department of Neurosurgery, West China Hospital, for reviewing the statistical analysis.
References (46)
- et al.
Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis
Lancet Neurol
(2009) - et al.
Hydrocephalus after aneurysmal subarachnoid hemorrhage
Neurosurg Clin North Am
(2010) - et al.
Acute hydrocephalus after subarachnoid hemorrhage–can it be caused by water vesicles of choroid plexuses?
World Neurosurg
(2013) - et al.
Predictors of shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage
World Neurosurg
(2016) - et al.
Predictors and outcomes of shunt-dependent hydrocephalus in patients with aneurysmal sub-arachnoid hemorrhage
BMC Surg
(2012) - et al.
Hydrocephalus in 389 patients with aneurysm-associated subarachnoid hemorrhage
J Clin Neurosci
(2013) - et al.
Incidence of ventricular shunt placement for hydrocephalus with clipping versus coiling for ruptured and unruptured cerebral aneurysms in the Nationwide Inpatient Sample database: 2002 to 2007
World Neurosurg
(2011) - et al.
Discriminant analysis prediction of the need for ventriculoperitoneal shunt after subarachnoid hemorrhage
J Stroke Cerebrovasc Dis
(2012) - et al.
Predictors of in-hospital shunt-dependent hydrocephalus following rupture of cerebral aneurysms
J Clin Neurosci
(2013) - et al.
International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion
Lancet
(2005)
Intrathecal lactate predicting hydrocephalus after aneurysmal subarachnoid hemorrhage
J Surg Res
Blood in the cerebrospinal fluid: resultant functional and organic alterations in the central nervous system a. experimental data
Arch Surg
The relationship of subarachnoid hemorrhage and the need for postoperative shunting
J Neurosurg
Predisposing factors related to shunt-dependent chronic hydrocephalus after aneurysmal subarachnoid hemorrhage
J Korean Neurosurg Soc
Chronic hydrocephalus after neurosurgical and endovascular treatment of ruptured intracranial aneurysms
Acta Radiol
Factors leading to hydrocephalus after aneurysmal subarachnoid hemorrhage
Minim Invasive Neurosurg
Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage
Neurosurgery
Predictors of long-term shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. Clinical article
J Neurosurg
Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage: incidence, predictors, and revision rates. Clinical article
J Neurosurg
Ventriculoperitoneal shunting after aneurysmal subarachnoid hemorrhage: analysis of the indications, complications, and outcome with a focus on patients with borderline ventriculomegaly
Neurosurgery
The impact of microsurgical fenestration of the lamina terminalis on shunt-dependent hydrocephalus and vasospasm after aneurysmal subarachnoid hemorrhage
Neurosurgery
Risk of shunt-dependent hydrocephalus after occlusion of ruptured intracranial aneurysms by surgical clipping or endovascular coiling: a single-institution series and meta-analysis
Neurosurgery
Chronic hydrocephalus in elderly patients following subarachnoid hemorrhage
Surg Neurol
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Zhiyi Xie and Xin Hu contributed equally to this work.
Supplementary digital content available online.