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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.

Author Information

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