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Early Ventriculoperitoneal Shunt Placement After Severe Aneurysmal Subarachnoid Hemorrhage: Role of Intraventricular Hemorrhage and Shunt Function

Kang, Dong-Hun MD; Park, Jaechan MD; Park, Seong-Hyun MD; Kim, Yong-Sun MD; Hwang, Sung-Kyoo MD, PhD; Hamm, In-Suk MD, PhD

doi: 10.1227/01.NEU.0000368385.74625.96
Clinical Studies

OBJECTIVE: This study investigated the outcome of early shunt placement in patients with poor-grade subarachnoid hemorrhage and the effect of intraventricular hemorrhage (IVH) and high proteinaceous cerebrospinal fluid (CSF) on subsequent shunt performance.

METHODS: This study included 33 consecutive patients with initial Fisher grade (3/4) subarachnoid hemorrhage who had undergone conversion from external ventricular drainage (EVD) to a ventriculoperitoneal (VP) shunt and whose computed tomography scan showed IVH at the time of shunt placement. Early weaning from an EVD and conversion to a VP shunt was performed irrespective of IVH or high protein content in the CSF.

RESULTS: The mean interval from EVD to VP shunt placement was 6.4 days. The mean volume of IVH was 9.44 mL, and the mean value of IVH/whole ventricle volume ratio (ie, percentage of blood suspension in the CSF) was 9.81%. The mean perioperative protein level in the CSF was 149 mg/dL. During the follow-up period, 2 patients (6.1%) required VP shunt placement, and no patients experienced complications of ventriculitis or shunt-related infection.

CONCLUSION: Based on our data, earlier EVD weaning and shunt placement can effectively treat subarachnoid hemorrhage–induced hydrocephalus in patients with severe subarachnoid hemorrhage. This procedure resulted in no shunt-related infections and a 6.1% revision rate. There were fewer adverse effects of IVH and protein on shunt performance. Therefore, weaning from an EVD and conversion to a permanent VP shunt need not be delayed because of IVH or proteinaceous CSF.

Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea (Kang) (Jaechan Park) (Seong-Hyun Park) (Hwang) (Hamm)

Department of Neuroradiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea (Kim)

Reprint requests: Jaechan Park, MD, Department of Neurosurgery, Kyungpook National University, 50, Samduk-2-ga, Jung-gu, Daegu, Republic of Korea 700-721. E-mail:

Received, February 24, 2009.

Accepted, September 25, 2009.

Copyright © by the Congress of Neurological Surgeons