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RISK OF SHUNTDEPENDENT HYDROCEPHALUS AFTER OCCLUSION OF RUPTURED INTRACRANIAL ANEURYSMS BY SURGICAL CLIPPING OR ENDOVASCULAR COILING: A SINGLEINSTITUTION SERIES AND METAANALYSIS

de Oliveira, Jean G. M.D.; Beck, Jürgen M.D.; Setzer, Matthias M.D.; Gerlach, Rüdiger M.D., Ph.D.; Vatter, Hartmut M.D.; Seifert, Volker M.D., Ph.D.; Raabe, Andreas M.D., Ph.D.

doi: 10.1227/01.neu.0000303188.72425.24
Clinical Studies

OBJECTIVE: To compare the risk of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by clipping versus coiling.

METHODS: We analyzed 596 patients prospectively added to our database from July of 1999 to November of 2005 concerning the risk of shunt dependency after clipping versus coiling. Factors analyzed included age; sex; Hunt and Hess grade; Fisher grade; acute hydrocephalus; intraventricular hemorrhage; angiographic vasospasm; and number, size, and location of aneurysms. In addition, a meta-analysis of available data from the literature was performed identifying four studies with quantitative data on the frequency of clip, coil, and shunt dependency.

RESULTS: The institutional series revealed Hunt and Hess grade, Fisher grade, acute hydrocephalus, intraventricular hemorrhage, and angiographic vasospasm as significant (P < 0.05) risk factors for shunt dependency after a univariate analysis. In a multivariate logistic regression analysis, we isolated intraventricular hemorrhage, acute hydrocephalus, and angiographic vasospasm as independent, significant risk factors for shunt dependency. The meta-analysis, including the current data, revealed a significantly higher risk for shunt dependency after coiling than after clipping (P = 0.01).

CONCLUSION: Clipping of a ruptured aneurysm may be associated with a lower risk for developing shunt dependency, possibly by clot removal. This might influence long-term outcome and surgical decision making.

Department of Neurosurgery, Neurocenter, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany

Reprint requests: Jean G. de Oliveira, M.D., Rua Sena Madureira, 1123 Apto.61, 04021–051, São Paulo-SP, Brazil. Email: jeangol@uol.com.br

Received, February 7, 2007.

Accepted, May 1, 2007.

Copyright © by the Congress of Neurological Surgeons