Shunt-Dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage: Investigation of Prognostic Variables and Creation of a Stronger Predictive Model.

Abstract

Aneurysmal subarachnoid hemorrhage (SAH) is frequently complicated by permanent shunt-dependent hydrocephalus, but it is difficult to predict which patients are at highest risk. This study seeks to identify novel variables associated with shunt dependency after aneurysmal SAH and to create a predictive algorithm that improves upon existing models. Retrospective case-control design was used. Patients who presented with aneurysmal SAH and external ventricular drain (EVD) placement were included. Those who successfully weaned off their EVD were compared with those who required shunt placement. Demographic and treatment data were analyzed using univariate and multivariable logistic regression. Receiver operating characteristic was used to compare the proposed model's performance against existing ones (Barrow Neurological Institute, chronic hydrocephalus ensuing from SAH score, and shunt dependency in SAH scores). One hundred patients were included: 50 no shunt and 50 shunt. Advanced age, elevated modified Graeb score, intraventricular hemorrhage, increased clot thickness, acute hydrocephalus, and cerebrospinal fluid protein >110 mg/dL prior to wean attempt were all found to be significantly associated with progression to shunt-dependency (P = 0.0351, 0.0022, 0.0407, 0.0274, 0.0014, and 0.0064, respectively). Multivariate regression demonstrated an area under the curve of 0.7852 (P < 0.0001), outperforming those of the other models. Our study suggests that elevated modified Graeb score on initial computed tomography and high cerebrospinal fluid protein levels prior to EVD wean are important prognostic indicators for the development of shunt dependency after aneurysmal SAH. Integrating these findings into clinical practice may aid in earlier and more targeted decision-making.