Faculty Collaboration Database

Clipping or coiling of ruptured cerebral aneurysms and shunt-dependent hydrocephalus. Neurocrit Care 2006;4(3):223-8

Date

06/08/2006

Pubmed ID

16757827

DOI

10.1385/NCC:4:3:223

Scopus ID

2-s2.0-33745726003 (requires institutional sign-in at Scopus site)   65 Citations

Abstract

BACKGROUND: Hydrocephalus may develop either early in the course of aneurysmal subarachnoid hemorrhage (SAH) or after the first 2 weeks. Because the amount of SAH is a predictor of hydrocephalus, the two available aneurysmal treatments, clipping or coiling, may lead to differences in the need for cerebrospinal fluid (CSF) diversion, as only surgery permits clot removal.

METHODS: Hospital and University Hospitals Consortium (UHC) databases were used to retrieve data on all patients admitted to our hospital with aneurysmal SAH during the last 4 years. The incidence of permanent ventricular shunt (VS) according to treatment modality used was evaluated.

RESULTS: One hundred eighty-eight patients were admitted with aneurysmal SAH. Coiling was performed on 48 (26%) and clipping on 135 (73.8%) patients. Fifty-six (31%) patients required CSF diversion. External ventricular drain was placed in 30 (22.2%) clipped and 13 (27.1%) coiled patients ( p = 0.5 ), and VS in 6 patients of the two treatment groups (4.4 versus 12.5%, respectively; p = 0.08). Patients requiring VS had longer UHC-expected hospital length of stay (LOS), as well as observed ICU and hospital LOS, compared to patients with temporary or no CSF diversion (24 +/- 14 versus 15 +/- 8, 20.5 +/- 9 versus 11 +/- 7, and 30 +/- 13 versus 16 +/- 11 days, respectively; p <or= 0.01). In a logistic regression model, VS was independently associated with rebleeding, external ventricular drain placement, coiling, and UHC-expected LOS (odds ratios, 95% confidence interval 12.1, 2.3 - 62.6, 6.9, 1.6 - 30, 6.25, 1.3 - 29, and 1.1, 1.02 - 1.14, respectively).

CONCLUSIONS: One-third of patients admitted with aneurysmal SAH require temporary or permanent CSF diversion. Permanent shunting was found to be associated with coiling in our patient population.

Author List

Varelas P, Helms A, Sinson G, Spanaki M, Hacein-Bey L

Authors

Ann K. Helms MD Professor in the Neurology department at Medical College of Wisconsin
Grant P. Sinson MD Associate Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aneurysm, Ruptured
Cerebrospinal Fluid Shunts
Embolization, Therapeutic
Female
Follow-Up Studies
Humans
Hydrocephalus
Intracranial Aneurysm
Male
Middle Aged
Neurosurgical Procedures
Retrospective Studies
Subarachnoid Hemorrhage